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

 

Samaritans Radar and Twitter’s Public Problem

Let me preface this by saying that contact from friends through Twitter when I have been at low points has absolutely saved my life. I would be dead if it were not for my friends on Twitter. Now, with that out of the way, read on.

The Samaritans have proudly launched a new app that when activated will alert the user to tweets from people they follow that might betray suicidal thoughts. When you sign up to Samaritans Radar it will watch the tweets of everyone that you follow and will email you as soon as it notices any tweets with key words and phrases related to depression. It is described as working through “a specially designed algorithm that looks for specific keywords and phrases within a Tweet.”

Spotting when a friend is low or suicidal is a laudable aim but this app immediately rings huge alarm bells for me. There are huge implications for privacy and consent. It seems that the Samaritans have considered only the privacy of the person that signs up to use the app, but says nothing about the privacy or consent of the people that the app monitors. In fact the website assures us that “The people you follow won’t know you’ve signed up to it and all alerts will be sent directly to your email address.”

The reaction to this app has been divided. On the one hand there are scores of people who seem very pleased with this and think it is a useful tool and a great idea. On the other hand, nearly everyone who I know who has or has had mental health problems has been immediately shocked, outraged and scared by it. The objections are many, including that people may self-censor if they think that they will trigger this app, that they may trigger it too often, that the app may be used by stalkers to pinpoint when a person is most vulnerable. Or spammers. Or evangelists. It is natural, then, to ask whether someone can reject Radar. Alas, it seems not. The Samaritans director of policy was asked the question and his response was troublesome to say the least: lock your Twitter account.

https://twitter.com/Ferns_Joe/status/527450160214056960

The idea that people should lock their account to avoid something is one that is also frequently used to defend harassment and to defend doing nothing about harassment. It always comes from people who have not experienced the issues that might drive a person to hide in that way and who thinks it acceptable to tell marginalised people to hide themselves if they don’t like society. It is unacceptable to drive people to hide rather than address a problem within society. The same viewpoint says that tweets are public and searchable therefore anything that people chose to do with them is OK. That is also unacceptable.

https://twitter.com/Ferns_Joe/status/527452663185948674

Radar may be limited only to those who follow me but I have over 6,000 followers. I follow only half that number, and I actually, really know only a few hundred at most. Among my followers are people who hate me and people who are my political enemies who are keeping tabs on my activities so limiting something to my followers is not good enough.

https://twitter.com/PaulAshYoung/status/527461305104744448

https://twitter.com/Ferns_Joe/status/527454616024539137

The suggestion that we don’t know how Twitter works is really insulting. People use Twitter in many different ways. For some Twitter is a news stream, for others it is a marketing channel. It is a place to chat with friends, a place to campaign politically, a place to turn for help, a place to commiserate. Twitter is just a place that humans inhabit and do human things in. The trouble is, Twitter doesn’t know this. The terms and conditions allow the whole stream of tweets to be sold to organisations for various purposes with or without consent.

Here’s the thing. We do know that tweeting is broadcasting. But tweeting is also a conversation among friends in a pub that can sometimes be overheard by others. Some of those others may be casual acquaintances, complete strangers, investigators from the DWP, or journalists. We may or may not care if they overhear. Sometimes something said to friends in a public place can be reported in the news worldwide. That doesn’t mean it’s what you expect to happen. Neither do we expect a mental health charity to create a tool that makes it easier to violate people’s boundaries.

Are you the kind of person that sneaks up to people’s private conversations to monitor them just because they’re in a public place? Because that doesn’t tell me I don’t know how things work, that tells me that you don’t know how society works. There’s an awful lot of people who have no idea of boundaries and think lack of technical block is society’s blessing to do something.

https://twitter.com/geeoharee/status/527461872589484033

https://twitter.com/IamMrJ/status/527459149068902401

The thing is, Samaritans almost get how Twitter can be used. On the Radar web page they say:

“Samaritans recognises that social media is increasingly being used as an outlet for people to share their feelings. In addition, there are some who may go online in the hope that someone will reach out and offer support.”

They must realise that the way a person sharing their feelings uses Twitter is different to the way that marketers or organisations use Twitter.

I think that the concept of an app that can alert a trusted friend about bad mental health episodes could have some merit however any such app must obtain full consent from the person being monitored and it must allow the individual to choose who they trust enough to receive the alerts. I might even use such an app in those circumstances.

Try again, Samaritans.

Please sign the petition to get Samaritans Radar shut down

Related Reading 

Former Samaritans volunteer @elphiemcdork: The Samaritans Radar app – the problem is right there in the name.

@YetAnotherLefty: On “Samaritans Radar”

@adrianshort: Samaritans Radar: paved with good intentions

Serious questions raised over whether Radar is compliant with the Data Protection Act:

@bainesy1969: Samaritans Radar – serious privacy concerns raised

@aimscetera: Email to Samaritans about Radar

@susanhalluk: Weary, Stale, Flat, Unprofitable – and in breach of the Data Protection Act

You can reach The Samaritans on 08457 90 90 90.

Broken thoughts

Brain not working.
Stressed. Worried. Don’t know why.
Can’t cope with anything. Anything at all.
Give up. Go to make coffee.
Coffee powder, coffee press. Wait for kettle.
Thinking.

“Kill yourself.”

Tiny words, hit me hard.
Stagger. Grab work surface to stay upright.

“KILL YOURSELF.”

NO!

Panic. Start to fall. Grab hold.
Hyperventilate. Tears. Can’t see, can’t think.

Time passes. Tears fall.

Legs hurt. Arms hurt. Still unsteady.
Frozen thoughts. Fear. Can’t break out.
Focus. Coffee.

Pause.

Pour the kettle. Make the coffee. Not thinking. Mustn’t think.
Mug, stick; stagger to bedroom.
Bed. Duvet. Hide.

Hide.

Mental illness is more disabling to me than physical illness

I have reached the point where mental illness is more disabling to me than physical illness. Before I became depressed I was physically ill with ME, diabetes and migraines and I was limited by fatigue and pain but I could write, I could repair computers, and I could focus to read or watch TV, as long as I planned around my illness. With regular rests and flexible timing I could engage with the world and get some things done. Now, though, depression and anxiety steal my focus for hours at a time and prevent me from completing even the simplest task. I start writing blog posts and manage one line. I start watching TV and manage 2 minutes of a half hour episode. I start games then give up. I drive to shops or friends and then can’t get out of the car. I look at my forms for help with power wheelchair costs and freeze up. The phone rings and I pull the duvet over my head.

My physical and mental illness seem to feed off each other too. If I reach a point of (even more than normal) exhaustion then I will also become overtaken by despair. Depression and anxiety also make it impossible to work towards improving my physical health. I need to get a routine and start pacing my activity but mental health problems mean that I can’t even think about doing things when I need to.

I’m not sure that I have a point in this blog post other than wanting to rant a bit. I suppose if anything my point is that depression is not some minor inconvenience. It is a real, crippling illness that will destroy a life just as effectively as any physical problem.

What are you afraid of?

Sitting at my computer – chatting, using twitter, writing a blog post.  Then suddenly it happens. A surge of fear. Heart thumping, pulse racing.

What are you afraid of?

I stop typing and sit back. Try to be calm. Think. What caused that? Why am I panicking? I don’t understand it.

What are you afraid of?

In my panic I stand up. Adrenaline strengthens my normally wobbly walking. I walk through the house. Remember that no one else is here. Then for no reason that I can think of I wonder where the cat is. She’s not on the bed, or the sofa. I stumble through the house, wobbly now, adrenaline or not. I don’t know what to do.

What are you afraid of?

I crash back into the living room. I find the cat sleeping on the floor next to the sofa. Relieved to find any living thing in the house, I fall down beside her. She glares at me.

What are you afraid of?

I put an arm around the cat, and my head on the floor. I close my eyes. My pulse is racing. Thumping. My head hurts. All the aching muscles that I had been resting after too much activity in the last few days are aching again. I reach for my phone, for twitter. Call out to anyone who is there. Friends are there. They are lovely, talking to me, helping me to calm down. The cat purrs a little, perhaps sensing my distress.

What are you afraid of?

Time passes. The floor is hard. The cat finishes purring and wanders off. I should move, but panic has left me exhausted. I have no energy.

What are you afraid of?

There is a fluffy polar bear behind me. I more to put my head on it. I lie there helpless.

What are you afraid of?

Then, at last, I hear a key in the door. Footsteps. A voice calls out.

Then help to sit on the sofa. Hugs. A cup of tea.

Feeling stupid, foolish.

What are you afraid of? I only wish that I knew.

Reply from PCC about Rod Liddle on fibromyalgia and ME

A few weeks ago I made a complaint to the Press Complaint Commission about a blog post written on The Spectator website by Rod Liddle. (Blog posts are covered if on a website of a print publication.) He asserted that fibromyalgia

“is another one of those imaginary afflictions claimed by malingering mentals.”

He went on to say

Things Which Definitely Are Not Illnesses or Diseases: 

Fibromyalgia
Addiction to alcohol
Addiction to drugs
Obesity
Being a bit odd
M.E.
Hepatitis contracted when behaving in an inappropriate manner
Stress
Wearing spectacles
Addiction to sex

This is the complaint that I sent in to the Press Complaints Commission. (And I must thank them for providing me with a copy as I had lost mine.)

Explanation : The article breaches the code of practice as it is inaccurate and misleading.

The article lists Fibromyalgia and M.E. under the heading “Things Which Definitely Are Not Illnesses or Diseases”

It is factually incorrect to state that these are not illnesses. Fibromyalgia is listed in the World Health Organisation’s Internationa l Statistical Classification of Diseases and Related Health Problems under M79 Other soft tissue disorders, not elsewhere classified, as M79.7, Fibromyalgia. Myalgic Encephalomyelitis (M.E.) is listed under G93 Other disorders of the nervous system as G93.3 Postviral fatigue syndrome – Benign myalgic encephalomyelitis.

The article states “[Fibromyalgia] is another one of those imaginary afflictions claimed by malingering mentals.”

The author has no grounds to claim that fibromyalgia is imaginary, as it recognised as a real physical illness by the WHO. He also has no grounds to use the phrase “malingering mentals.” Fibromyalgia is not a mental illness, and even if it were, a mental illness is a real illness and is not “malingering.” This phrase is incorrect and is disablist hate speech. The errors in this article contribute directly to hate crime, abuse, and verbal abuse against sick and disabled people, of which there has been a significant increase in rece nt months. (As reported by Scope at http://www.scope.org.uk/news/matthew-parris-and-times)

Clauses : The article breaches clause 1 part 1 of the code of practice.
i) The Press must take care not to publish inaccurate, misleading or distorted information, including pictures.

And here is their response.

Commission’s decision in the case of

Various v The Spectator 

The complainants considered that an article that stated that Fibromyalgia (FM) was not a real illness and that sufferers were “malingering mentals” was inaccurate and discriminatory.

The Commission acknowledged that the article was controversial and that many readers would not agree with its content, however, it made clear that columnists are entitled to express their personal views and comments, provided they are clearly distinguished from fact. It noted that the column was written in the first person and as such, the views expressed were clearly attributable to the columnist.

The Commission considered first the complaint under Clause 1 (Accuracy) of the Code. The Commission acknowledged that the complainants considered that the article’s reference to the columnist being a doctor and the statement that Fibromyalgia (FM) and other recognised diseases were not “real” was inaccurate. The Commission considered that readers in general would understand that the reference to the columnist being a doctor was intended to be a facetious reference rather than a statement of fact that he was a qualified medical practitioner. As such they would not be misled. Furthermore, the Commission considered that the categorization of the illnesses clearly represented the columnist’s opinion on the conditions – indeed he clearly qualified his views on Fibromyalgia by asserting he “may be wrong”. The Commission considered that readers would understand that it reflected the personal, albeit caustic views of the columnist and would not be misled by the article; as such it did not establish a breach of Clause 1 (Accuracy) of the Code.

The Commission then turned to the alleged breach of Clause 12 (Discrimination) of the Code. It appreciated the reasons why the complainants considered the article was distasteful and prejudicial and acknowledged that many readers would take offence at the article; however this did not render a breach of Clause 12. The Commission made clear that under Clause 12 (i), newspapers must avoid prejudicial or pejorative reference to an individual’s physical or mental illness or disability; the clause does not cover references to groups or categories of people. In this instance, the article did not make reference to the physical or mental illness or disability of a particular individual but rather referred to Fibromyalgia sufferers in general. While the Commission understood the concerns raised by the complainants, it did not establish that Clause 12 (i) of the Code had been breached.

Finally, the Commission considered the complainants’ concerns that the magazine published offensive material. It acknowledged that the complainants found the article highly offensive; however, it made clear that the terms of the Editors’ Code of Practice do not address issues of taste and offence. The Code is designed to address the potentially competing rights of freedom of expression and other rights of individuals, such as privacy. Newspapers and magazines have editorial freedom to publish what they consider to be appropriate provided that the rights of individuals – enshrined in the terms of the Code which specifically defines and protects these rights – are not compromised.  To come to an inevitably subjective judgement as to whether such material is tasteless or offensive would amount to the Commission acting as a moral arbiter, which can lead to censorship. It could not, therefore, comment on this aspect of the complaint further.

 

Sick? No you’re not!

This news item is worrying. Scary, in fact.  GPs should ‘not sign off long-term sick’ [BBC] I’ve quoted most of it here, with my responses.

People should be signed off for long-term sickness by an independent assessment service and not GPs, a government-backed review says.

Strange. The government trusts GPs to run the NHS but not to decide who is too sick to work. Yet they trust Atos and Group 4 who have a proven record of ignoring evidence and making wrong decisions. I wonder which company the government will outsource this “independent” assessment service to?

The review also suggests tax breaks for firms which employ people who suffer from long-term conditions.

This, I actually like.

It is estimated the changes would send 20% of those off sick back to work.

This is blatantly a move in favour of employers and against employees. Tories always side with people with money. Perhaps the government should instead ask why so many people are sick.

A Department for Work and Pensions spokesman said: “The government is committed to supporting more people with health conditions to work.”

Supporting? They mean forcing. Whether it’s what people need for their health or not.

Around 300,000 people a year are absent from work due to long-term sickness.

Perhaps there is some problem other than people pretending to be sick. Perhaps being forced to do too much work for too little pay is the problem. Perhaps employers should pay more and stop sacking people and then forcing other employees to do the work of more than one person.

The review also calls for a new government backed job-brokering service, to find work for people cannot stay in their current job because of their condition.

Great idea. But don’t force it on people that shouldn’t be working at all.

A survey suggested 77% of GPs had admitted they signed people off sick for reasons other than their physical health, the report authors told the BBC.

What, like MENTAL HEALTH? This is an absurd, biased statement that ignores a huge part of health care.

The government asked Professor Carol Black and the former head of the British Chambers of Commerce David Frost to consider radical changes to deal with the human and financial cost of sickness absence in the workplace.

Ah. “Deal with”. Because it must not really be sickness.

If the recommendations are accepted people who are signed off sick would also be put on to Job Seekers’ Allowance, instead of Employment Support Allowance, for a period of three months.

They would receive less money and have to prove they were looking for work.aul

This is outrageous. In fact, it’s evil. When someone has been signed off sick the last thing they need is to be forced to look for work. Being made to visit the job centre every fortnight can be very difficult and highly damaging to what little health remains. Looking for a more suitable job means being forced to leave the job you are in and abandon hope of going back which can be crushing. Even if there are jobs which a sick person could manage to fit around their problems, most employers would hire a healthy person, which means endless applications and rejections which cause stress, which in turn aggravates both mental and physical health problems. Sometimes a GP will sign a person off work because they need rest, both physical and mental, in order to recover from their illness.

The government’s new policy to deal with the costs of sickness in the workplace appears to be to pretend that people aren’t sick at all.

 

—Update—

As is pointed out by Paul Cotterill at Liberal Conspiracy, Atos founded the Commercial Occupational Health Providers Association (COHPA) which has seats on Dame Carol Black’s select committee for occupational health and the Council for Work and Health. COHPA boasts

COHPA has been active politically in trying to represent the interests of commercial OH providers to Dame Carol Black, Government and key bodies in the industry.

It seems likely that Atos will be well-placed to bid to carry out these assessments.

Mental ME

I have depression. I get stuck in a spiral of negative thoughts until I reach the point of wanting to die. It happens often, and has been going on for about a year. A few months ago I asked my GP to refer me to a mental health team for more in-depth help as anti-depressants alone were not working.  My GP wrote to the mental health team asking for help with my suicidal thoughts, and she listed some of my circumstances too – imminent homelessness, massive housing benefit screw-up, and suffering from ME and lots of other diseases.

The three times that I have seen a psychiatrist have been rubbish. I talked about that in a previous blog post. Basically, the psychiatrist focussed on my fatigue and would talk about nothing else. I even said to him “I’ve had M.E. for eleven years and know how to manage it, but I really need to know how to stop the loops of negative thought and the suicidal thoughts.” I was ignored. He decided to treat my fatigue by giving me amitriptyline, which is the first drug used in cases of M.E. even though I have tried many similar drugs over the years to no effect. Amitriptyline caused me to lose two entire weeks because it made me sleep all day every day, so I cut it down and then stopped it.

I went back to my GP to find an alternative to this useless psychiatrist. She gave me a copy of the letter that he had sent to her. Here is what it says:

Diagnosis: Chronic Fatigue Syndrome

Current Mental State/Progress:
Unchanged, symptoms of fatigue.

Risk profile (+Crisis Plan if applicable):
Nil.

There is no mention of the periods of despair, the suicidal thoughts, the risk to myself that my GP had told them about. Just a diagnosis of Chronic Fatigue Syndrome. I have pointed out on this blog many times before that my illness is ME/CFS which is a physical condition. As such, my psychiatrist has no business writing CFS as my diagnosis for my mental health problems because it’s not a mental health problem.

I had a bit of a freak out this morning because I suddenly realised that this psychiatrist will be asked about my condition for my application for Disability Living Allowance. That could be disastrous if he tells them his version of what is wrong with me rather than my official diagnosis of M.E. by the neurologist that I saw years ago. However, after panicking for a few hours I have managed to call the mental health hospital and explain my problem. The manager there was extremely helpful and nice about it. My next appointment there will be with the Consultant Psychiatrist who is in charge rather than the idiot that I have previously seen, and because my DLA claim is imminent I will be called in earlier if there are any cancellations. She has also made a note that they must see me before replying to any letters about my DLA claim.

Hopefully that’s one less thing to worry about. The last thing I need is clueless doctors making my life even more stressful.