Mental health treatment in the Job Centre – what could possibly go wrong?

A Mental Health task force set up by Nick Clegg has decided to subject people on benefits to mental health treatment at the Job Centre.

Out of all the possible environments for mental health treatment, the Job Centre could the worst.

The treatment will take the form of talking therapy and computer-based Cognitive Behavioural Therapy. A posting on the governments’s Contracts Finder website reveals that the DWP intend to spend £21 million on the online CBT. It is not clear how much they intend to spend on human therapists, where they think they can get them, or whether they will actually have training and experience to do the job.

There are so many problems with this scheme that it is hard to know where to start. The biggest problem I can see is that there can be no meaningful consent to treatment in the context of the Job Centre. Where once the Job Centre was there to help people to find a job, these days it is more known for ruthless sanctions and cutting off benefits for whatever trivial excuse they can come  up with. If Job Centre staff tell someone that they need mental health treatment it will be backed up with words such as “your benefits may be affected if you do not attend” which is a barely-veiled threat that they apply to most “voluntary” tasks that they inflict on people.

The regime of sanctions and workfare means that the Job Centre is a direct cause of much mental illness among people on benefits. I cannot see anyone wanting to reveal this to any therapist in the Job Centre even if absolute confidentiallity is promised. There is too much danger of it leaking to vindictive staff who are eager to hit their targets for sanctions.

Computer-based CBT could be even worse. CBT does not work for everyone and there is a chance that staff will use failure to get better as an indication that someone is not trying, and an excuse to cut their benefits. CBT often makes people worse before they get better and it is not something that should be done in a public place where there is little chance of privacy. It could leave people in a raw emotional state and vulnerable while out in public, or the setting may prevent people from engaging at all. Indeed, the suspicion will be that Job Centre staff will monitor progress just like they monitor the Universal Job Match system.Whether true or not, that will be a barrier to a lot of people.

This whole scheme seems to have been set up with the primary aim not of improving mental health, but of getting people in to a job. There is no indication of how the DWP will treat people whose mental health does not improve enough to get a job, or even get worse. Clegg’s mental health task force seems to have no clue about the reality of unemployment, poverty or illness. Had they asked anyone in this situation they would have been told that this plan will be damaging, not helpful.

If there is money available – and seemingly, there is at least £57 million available – why on earth isn’t it being spent within the NHS to undo some of the savage cuts that have taken place? Lots of people including myself have been desperate to get proper talking therapy from the NHS for years but unable to do so. Tories and LibDems seem desperate to force unsuitable treatment without consent on people on benefits instead of properly funding NHS services. This scheme is a useless bandage on the gaping wound inflicted by this government and it will do more damage than it helps repair.

Related Links

Clegg announces plan for job centre mental health treatment scheme

Nick Clegg holds first meeting of mental health taskforce

Contracts Finder: Online Supported Cognitive Behavioural Therapy

 

PIP judicial review: Court rules against us but vindicates our case

We lost. The judge ruled that in the end the consultation process for PIP was not unfair.

However that is not the whole story. You see, the judge found that it was the second consultation that made things right. The first consultation, he had some harsher words for. Words such as:

“Unfortunately mind-bogglingly opaque.” (Paragraph 105 part ii)
“At best ambivalent” (Paragraph 105 part vii)
“Convoluted, inherently unclear, ambiguous and confusing.  No construction allows for full coherence.” (Paragraph 106)

Not exactly a ringing endorsement of the way the government chose to do things, I think you’ll agree.  The government’s legal team also agreed, and in fact they have accepted that they must share a portion of the costs of this judicial review in the face of evidence that it was indeed justified.

Not only that, but the government made it perfectly clear that they know exactly how much their policies will hurt people but want to do it anyway.

“… [T]his was recognised from the outset.  In developing the PIP assessment we were aware that the vast majority of recipients of DLA were individuals with genuine health conditions and disabilities and genuine need, and that removing or reducing that benefit may affect their daily lives.  However, we believe that these impacts can be justified as being a logical result of distributing limited resources in a different and more sustainable way…”.
(Paragraph 80)

Let’s see that again:

we were aware that the vast majority of recipients of DLA were individuals with genuine health conditions and disabilities and genuine need, and that removing or reducing that benefit may affect their daily lives.”

And again:

“genuine need”

So we have the government’s lawyers arguing that the DWP and the government ministers know full well that they are removing vital support from hundreds of thousands of people who have few other options and who will suffer as a result. And they are doing it to save money.

The judge agreed with the DWP that taking money from physically disabled people to allocate to other PIP claimants achieves “substantive equality between physically and non-physically disabled.” I argue that this has reduced the equality of physically disabled people compared to not-yet-disabled people, purely because of budget.

This is Lowest common denominator equality.

This is your government. This is what the society that we live in is prepared to accept.

The court’s findings and what’s next

The judge was persuaded by Dr Bolton’s evidence that the government could have changed their decision had they decided to listen to the overwhelming opposition to the 20m rule in the second consultation, and so it was not unfair. My legal team and I disagree. We still argue that the decision had long since been made and that the secretary of state had a closed mind by this point, and so the second consultation was not at a formative stage.

Although the judgment went against us I feel that the judge’s analysis of the first consultation is vindication for our bringing this case to court. Don’t forget that the second consultation only came about after this case was given permission to proceed and the DWP realised that they could not get away with such a shambles.

I hope that the admission by the government that they know exactly what they are doing will make people wake up to what is happening. Meanwhile, this is not the end. The legal team and I are considering our options to appeal this result.

Press Release from Public Law Solicitors

PIP Consultation Judicial Review Press Release

Read the full judgment

PIP consultation judicial review starts today

Two weeks until PIP Judicial Review – 20 metre limit in the dock

Replacement of disability living allowance headline news for hours

Why I am suing the government

Ingeus recruiting “Health Advisors” for DWP forced “bio-psychosocial health assessments”

Ingeus advert

Welfare-to-work provider Ingeus are recruiting Occupational Therapists to become “Health Advisors” as part of a pilot scheme to help people on ESA (sickness benefits) to return to work. As I wrote yesterday, people receiving ESA in the Work Related Activity Group will be forced to see these Health Advisors and will lose their benefits if they do not. This is a huge problem for all kinds of reasons which you can read about in my previous blog postAn advert placed by Ingeus on the website of the Vocational Rehabilitation Association reveals more details of how the scheme will work.

“From 25th November 2013 Ingeus will be delivering a new Department for Work & Pensions (DWP) Health Professional led contract for customers claiming Employment and Support Allowance (ESA) with an 18-24 month prognosis post Work Capability Assessment (WCA). The 2 year pilot programme will ensure clients have access to suitably trained Health Professionals to support the management of their health and wellbeing. We are looking to recruit Occupational Therapists to deliver the ESA pilot across the Central Region.”

It gets worse though. Perhaps unsurprisingly, the words “Bio-psychosocial model” make an appearance.

Delivering bio-psychosocial initial health assessments to identify clients health related concerns and barriers to returning to work, usually taking place via face to face 1:1 appointments but may also require telephone based interventions as well as on occasions a home/community visit.”

The Bio-Psychosocial model of disability is what the government have adopted after decades of being advised by insurance company UNUM. The model basically says that disability is all in the mind of the disabled person and they only need to adopt a better attitude to overcome barriers to work and other activities. It places blame for being ill on the patient and insists that they can just think their way better, as though thinking can eradicate viruses or fix broken genes or regrow broken or missing body parts.

I think access to an extra doctor, nurse, OT or some one else could really be a great help to a lot of sick and disabled people but not through this scheme. Any extra healthcare needs to be consensual and voluntary, this is not. The money spent on this scheme would be far more useful given to the NHS. And as for this scheme using the bio-psychosocial model, you might as well just tell sick and disabled people to “snap out of it”.

Where’s The Benefit: Models of Disability

Vocational Rehabilitation Association: Ingeus advert

Sick people to be forced to talk to the DWP’s own “healthcare professionals”

Being accused of DLA fraud may force you to apply for PIP

The Benefits and Work website claims that people will lose their Disability Living Allowance permanently if someone accuses them of fraud. There is some truth behind this claim but the headline is a wild speculation from the information that they actually have.

The facts behind the story are this:

People who currently receive DLA will all be “invited” to apply for Personal Independence Payments over the next few years. A large number of people who receive DLA are not expected to qualify for the same level of support from PIP and so this move is rightly feared by many. People can apply for PIP before their DLA runs out if they wish – these are “self selectors” in DWP speak. Anyone whose care or mobility needs change will have to apply for PIP rather than alter their DLA claim. As long as nothing changes, most people can remain on DLA until 2015 or the end of their award.

The scary part of this story comes from a quote that Benefits and Work found on Rightsnet.

“At our local JC+/customer/representative forum meeting last week a DWP partner support manager brought the following change of wording to the attention of the meeting (second bullet point on page one of link)

In his words anyone who was ‘bubbled’ (shopped) would be taken as if they were a ‘self selector’ in the DLA/PIP reassessments.

Nothing appears to have been changed in the PIP trans regs to allow this but it is worrying when the PIP/DWP ‘thinking’ changes the words ‘those claimants where we receive information…’ from the actual legislation.”

The source claims that anyone who is reported to the DWP for fraud will be treated as if they have reported a change and therefore have to apply for PIP.

This is a fairly tenuous link, but a worrying one all the same. The overwhelming majority of reports to the benefit fraud hotline are either malicious or wrong and the fraud rate for DLA is incredibly low. If all that is required to trigger the move to PIP is a false report then a lot of people are going to be badly affected. However, we do not know whether this second-hand claim is true, or whether the practice will be widespread or just confined to one or two areas, and we do not know if a person will have to be found guilty of benefit fraud or just reported – the wording could mean either. Given the history of the DWP’s approach to sanctions I wouldn’t say it is out of the question for this to happen against the rules, but we will have to wait and see about that.

I find the way that Benefits and Work have reported this to be irresponsible and misleading. In their email they stated that “The DWP have ruled that…” when there is no such ruling, only a second-hand report. They also missed out the third sentence from their quote, which stated that nothing has changed in the PIP regulations.

I do not think anyone should worry about being moved because of a malicious fraud report, at least until we have more evidence.

Benefits and Work: Claimants to lose DLA permanently if falsely accused of fraud, DWP decides