The Unspoken Illness - We Need to Talk About Mental Health

Each year on the 10th October organisations and charities from around the globe take part in World Mental Health Day to raise awareness of mental health issues.

WoW Petition will be joining the discussion. You can follow us on twitter @WOWpetition and @WOWpetitionchat and on facebook

We urge you to sign
http://epetitions.direct.gov.uk/petitions/43154
to demand that no one with a mental illness should suffer hardship and distress as a result of welfare reforms. 

WoW Petition calls for an independent, committee-based inquiry into welfare reform including "universal mental health treatments." What does this mean? The answer is simple. We believe that no one experiencing a mental health condition, illness or mental distress should be denied access to the support, care and treatment that they deserve and need.

Mental health problems are widespread in the UK:

• Mental illness accounts for half of all illness in the under 65s. 

• According to the World Health Organisation, one in four of us will have a mental illness at some point in our lifetime.

• One in six people are currently affected by a mental illness.

• 6,000,000 people have depression or crippling anxiety conditions.

• 700,000 children have problem behaviours, anxiety or depression.

• One third of all families include someone who is currently mentally ill.

The human impact of mental illness :

• Suicide is the most common cause of death in men up to the age of 35.

• Around 4,400 people end their own lives in England each year. That's one death every two hours. At least 10 times that number attempt suicide. Around 90% of suicide victims suffer from a psychiatric disorder at the time of their death.

• Mental illness has the same effect on life-expectancy as smoking, and more than obesity.

• Mental illness is generally more debilitating than most chronic physical conditions. On average, a person with depression is at least 50% more disabled than someone with angina, arthritis, asthma or diabetes. 

• Mental pain is as real as physical pain, and it is often more severe. 

• The UK has one of the highest rates of self harm in Europe at 400 per 100,000 population. 

• People with serious mental illnesses die on average 20 years earlier than the rest of the population.

Neglecting mental health blights millions of lives, and yet, despite the huge cost to the economy and our society, three-quarters of people with common mental heath conditions are not receiving any treatment, therapy or support. 

Lack of funding and cuts:

For the first time in a decade there has been a cut in the total spending on mental health with a reduction of £150 million, including cuts in crisis services and out-reach programmes. This at a time of austerity when cuts to the welfare system further compound mental health problems. In many parts of the country, crisis care teams are under-resourced, understaffed and overstretched.

Mind chief executive Paul Farmer. "The current economic climate, unemployment and benefits cuts are likely to be having an impact, but we know too that people in a mental health crisis aren't always getting the help and support they need from the services there to support them."

"Good services can make a huge difference to whether someone recovers from a mental health crisis, yet we often hear from people who have been turned away because they 'aren't suicidal enough' or who have been made to wait for hours to be assessed and offered help."

"When people in crisis don't get the help they need, the consequences can be catastrophic."

• In 2012 the number of suicides among mental health patients rose from 1,175 to 1,333.

• Suicides are three times higher among unemployed people.

WoW Petition calls for an Independent, Committee-Based Inquiry into Welfare Reform, covering "excess claimant deaths".

We don't know how many people with mental illness have died after being judged fit-to-work following a work capability assessment or were appealing a fit-to-work decision because the Department of Work and Pensions say that they don't hold this information. As stories of suicides and deaths linked to the assessment appear in the media we can be sure that people have died as a consequence. The tick-box assessment is completely inadequate in recognising the many difficulties and limitations endured by mentally ill people. The stress and fear surrounding the assessment can be unbearable for many, making symptoms much worse. Medical evidence is disregarded and failure to collect supportive documentation at the start of the process means that people with learning disabilities, autism and psychotic illness especially, are discriminated against by the system. The High Court has ruled that the assessment for employment and support allowance breaches equalities laws but the government are appealing this judgement.

WoW Petition calls for an immediate end to the Work Capability Assessment as voted for by the BMA & RCN.

Mental health services are not regarded as a priority. The government have given local NHS service commissioners £400 million to complete the roll out of improving access to psychological therapies. By 2014 the programme should have been treating 900,000 people suffering with anxiety and depression but the budgets have not always been used for their intended purpose. 50% of these people receiving treatment would be expected to recover. Mental illness can make existing physical illness worse and it can cause physical symptoms. Physical healthcare caused by mental illness costs the NHS at least £10 billion. Not only does therapy help recovery and improves quality of life but economically it would be cost-effective to invest more on psychological therapies now saving on costs for other health services later.

• Despite the widespread prevalence of mental illness within the UK, mental health services only receive 13% of NHS health expenditure.

Anxiety conditions such as social phobia, agoraphobia, PTSD, OCD, panic disorder and generalised anxiety account for half of mental illness. They can be debilitating and disabling and if not treated they frequently become lifelong. Recovery is made much more difficult the longer these conditions are left to persist untreated. There is no right to therapies within the NHS which NICE recommend as an effictive form of treatment for such conditions.

People are often afraid to admit they have a problem due to the stigma attached with having a mental illness and do not seek help when symptoms first appear. They need to get help as soon as possible to prevent their symptoms from escalating to crisis point but when they go to see their GP they may not get the referral to the local mental health services that they require.

GPs themselves are often not adequately trained in mental illness and the patient comes away with nothing more than a prescription. There can be very long waiting times for psychological and talking therapies and counselling and sometimes no local services to help at all.

Mind Charity revealed that one in five people had been waiting over a year to receive treatment and one in ten over two years. They say:

"Waiting times can have a devastating impact on a person's life. They can exacerbate mental illness and cause relationships to break down, jobs to be lost, people to be isolated and, in extreme cases, lead to suicide attempts. But far too many people are still waiting far too long to receive treatment."

Employment:

• Mental illness accounts for nearly half of all people on sickness benefits.

• People with severe mental health problems have a lower employment rate than any other disabled group and yet they are more likely to want to work. 90% say they'd like to have employment compared to people with 52% of disabled people generally. 

• However, only 21% of people with a disabling mental health condition are in paid employment compared with 47% of all people with other disabilities. This is even less for people with a severe mental illness. Just 9% are working full time and 19% part-time.

•  70% of those with a common mental disorder who are unemployed and seeking work and have been unemployed for over a year or more are unlikely to return to work.

People with mental illness judged unfit to work in the short to medium term have not been excluded from the Work Programme. The scheme is mandatory and failure to participate can lead to mentally ill people being stripped of their benefits.

• 93% of disabled people put onto the Work Programme are not finding long-term work. Just 6.8% of new ESA claimants with a general range of disabilities referred to the scheme in the latest three months have found employment. 

The public are not so sympathetic. 75% said people who were ‘mentally disabled’ (judged fit) should be made to work unpaid for their benefits.

Mind chief executive Paul Farmer. “Pressuring people into working, under the threat of losing their benefits, often serves to exacerbate their mental health problems, pushing them even further from the job market. Currently there’s still too little specialised support available and too much focus on sanctions and conditionality. People with mental health problems face significant barriers to finding and staying in work, such as stigma from employers, and often dealing with an invisible and fluctuating condition. The Government should be ensuring they provide tailored support to help people find appropriate employment.”

WoW Petition is opposed to workfare for people claiming social security benefits. WoW Petition calls for "an end to forced work under threat of sanctions for people on disability benefits".

Stigma and discrimination:

• Fewer than 4 in 10 employers say that they would consider employing someone with a history of mental illness compared with 6 out of 10 who would consider giving work to someone with a physical disability.

Public attitudes towards mentally ill people have hardened.

• More than half of the UK public said if they were employers they would not offer people with a history of depression a job, even if they were the best candidate. 

However, we probably each already know and work with someone suffering from a mental health problem, only because of stigma and discrimination, we don't know that they have an illness.

The media have shaped our attitudes towards mental illness and particularly our misinformed view that 'mental patients' are prone to violence. The stark reality is that sufferers are significantly more likely to harm themselves than other people and be the victims of crime and abuse.

Supermarkets Asda and Tesco recently had to remove offensive "mental patient" fancy dress costumes from their stores after a public outcry.

People with mental health problems are often too afraid to seek help or even to say they are unwell because of fear of being harshly judged and misunderstood. Sensational headlines can only make people more fearful of opening up, less likely to talk about their concerns and get the support they need. Stigma blights lives.

• Nearly nine out of ten people (87%) with mental health problems say that have been affected by stigma and discrimination.

Stigma can affect all aspects of daily life. Work, education, going shopping and leisure activities, friendships, socialising, talking to other people, and getting support. People feel that they get a negative reaction and are blamed for their illness. That they will be seen as weak if they can't 'pull up their socks' or 'pull themselves together'. Asking a person with depression to 'cheer up' is like asking someone with a heart condition to make themselves better.

Stigma creates isolation and loneliness as people withdraw from social contact, which lowers their self-esteem and confidence. Two thirds of people with mental health problems live alone, four times more than the general population. Few people send get well messages as they do when someone is ill with a physical condition. The general message is that if you have a mental illness you suffer in secret, hidden away from the world and you don't talk about it. When someone asks how you are, few would venture to say that they're feeling down or anxious or depressed.

It's time that people with mental health issues were treated fairly. People with mental health problems can and do recover to lead rewarding and fulfilling lives. Not everybody can and will be cured, but equality and accessibility to treatment and support to enjoy life's potential should be the same experience for everybody.

Attitudes to mental health need to change.


Please support our campaign by signing WoW Petition



Sources:
http://www.who.int/mental_health/world-mental-health-day/en/index.html
http://cep.lse.ac.uk/pubs/download/special/cepsp26.pdf
http://www.mentalhealth.org.uk/content/assets/PDF/publications/fundamental_facts_2007.pdf?view=Standard
http://www.nmhdu.org.uk/silo/files/nmhdu-factfile-6.pdf
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212266/hwwb-mental-health-and-work.pdf
http://www.parliament.uk/business/committees/committees-a-z/commons-select/public-accounts-committee/news/contract-management-of-medical-services/
http://www.samaritans.org/sites/default/files/kcfinder/files/research/Samaritans%20Suicide%20Statistics%20Report%202013.pdf
http://www.telegraph.co.uk/health/healthnews/10074192/Judges-rule-back-to-work-assessments-unfair-to-mentally-ill.html
http://www.time-to-change.org.uk/sites/default/files/Stigma%20Shout.pdf
http://mentalhealthcop.files.wordpress.com/2013/10/vssummary.pdf
http://www.newstatesman.com/economics/2013/10/disabled-and-work-programme-cold-calling-companies-8-16-hours-week
http://www.mind.org.uk/assets/0001/0027/Mind_We_need_to_talk_Report.pdf
http://www.bbc.co.uk/news/health-23163724

The Perils of Being a "Vulnerable" Benefit Claimant

Today, the Commons Public Accounts Committee published its report into some of the activities of JobCentre Plus (JCP), managed by the Department for Work & Pensions (DWP). Despite being snowed under with other work, I’ve read some of the report with interest, since I know very well that sick & disabled people who are dependent on benefits are often treated very badly indeed by the system that’s supposed to support them.

As an aside, I dislike the word “vulnerable”, as it tends to be used in relation to most or all sick & disabled people, and there’s no automatic reason why people have to be considered vulnerable just because they happen to be disabled. However, I do think  most sick or disabled people who are dependent on benefits are made vulnerable by the benefits system itself, which is steadily becoming less supportive and more punitive. Indeed, in a meeting I attended yesterday, we were reflecting that we really don’t believe punishing people and making their lives more and more stressful is going to “change their behaviour”, which in DWP-speak means “make them get a job”. Quite the reverse; the more punitive the measures taken against sick & disabled people and the more hardship they suffer, the more stressed they will become and the more their health will worsen. It’s not rocket science! If DWP doesn’t understand that, it’s because they don’t want to.

Anyway, back to the report. It doesn’t pull its punches, but it’s written dispassionately, of course, as befits a Parliamentary report. One of its principal concerns is that:

The Department [DWP] measures the performance of jobcentres by the number of people that stop claiming benefits.

As a disabled campaigner, this seems to me to encapsulate all that is wrong with the way DWP, JCP and their staff operate, at the behest of their ministerial team. The organisation is driven by the aim of removing support from claimants, rather than a more positive, humane and civilised aim of maximising their well-being – through work if that’s possible or through the support of benefits if it’s not.

I think the report strikes a good balance – it acknowledges that claimants need to do their bit to get a job if they can, but it points out that measuring how many people come off benefits is not the same as measuring how many get into work. Crucially, the Committee says:

The Department does not measure, however, how many people each jobcentre has helped into work or have a complete understanding of why claimants have left the benefit system.

Again, it’s not rocket science, and campaigners have long been especially concerned about what happens to people who are found “fit for work” at their Work Capability Assessment (WCA) but are unable to claim Jobseeker’s Allowance (JSA) because they’re actually not well enough to work. In theory, they could end up with no money to live on; this is likely to be an even bigger problem when mandatory reconsideration before appeal is implemented for Employment & Support Allowance (ESA).

The report also points out that the principal performance indicator (how many people stop claiming benefits) increases the risk that sanctions may be used to force people off benefits; the committee says:

The focus on how many people stop claiming benefits… raises the risk that jobcentres may unfairly apply sanctions to encourage claimants off the register.

They report evidence from Citizens Advice, who say they’re supporting increasing numbers of “vulnerable” clients who have been sanctioned – some of whom have little or no understanding of why their benefits have been stopped.

The report also finds that Employment & Support Allowance (ESA) claimants generally receive a worse service than those on JSA – unsurprisingly it seems it’s not only Work Programme providers who “park” sick & disabled claimants. However, the reality behind this finding is that in the real world, regardless of the Equality Act, an employer who receives hundreds of applications for a vacancy is much more likely to give the job to someone who is not sick or disabled. JCP advisers aren’t daft; on the contrary, I imagine they’ll be even more aware of this obvious reality than the rest of us, and when they’re under pressure to perform, will naturally prioritise those claimants who are more attractive to potential employers. In this context, the Government doesn’t appear to understand the basics of supply and demand in the labour market, so perhaps I should spell it out:  when there are many more potential employees than there are positions available, employers can be choosy; in these circumstances, blaming the sick or disabled person for not succeeding in finding employment is, frankly, cruel.

Finally, for this blog at least, there’s another humane conclusion from the committee:

DWP has a responsibility to ensure that more vulnerable individuals are able to claim the benefits to which they are entitled.

DWP managers need to repeat this mantra to themselves every morning and every night, for as long as necessary, and apply it in the way they run their Department and manage Jobcentre Plus. Otherwise, sick & disabled claimants, especially those with mental health needs or learning difficulties, will continue to suffer appallingly in a system that appears to neither know nor care what happens to them and their families.

And before I upload, I’ve just seen that the Telegraph has noticed the effectiveness and influence of the Chair of the Public Accounts Committee, Margaret Hodge. More power to her elbow!


This post was written and reproduced courtesy of Jane Young (@theyoungjane)

Too Sick to Work? Attend the Work Programme or Face Sanctions!

On the 3rd December 2012 the DWP announced that people who had been through the exceptionally tough Atos work capability assessment and found to be not fit for work could be mandated indefinitely onto the work programme or have their income sanctioned. This new rule applied to people in the work related activity group. People, who according to the government, should be expected to recover within twelve months. This group includes the greatest proportion of sick and disabled people receiving ESA. The support group is so difficult to get into that it excludes many of those with degenerative and fluctuating illnesses, chronic conditions that have gone on for years and cases of terminal illness when they are expected to live longer than six months. Of course you'd want to spend your final months doing some work experience to improve your future job prospects wouldn't you?

It's plain to see that the work related activity group is fast becoming indistinguishable from job seekers allowance. Coalition politicians have stopped referring to it as a disability benefit and the media has frequently included the sick and disabled people in the group as people found fit to work. The benefit was also one of those capped at 1% and it will not increase in line with inflation. Dividing sick and disabled people up with a points scoring system into two groups, has always seemed to be flawed and unfair to me. If you're too sick to work, then you're too sick to work. How difficult can that fact be to understand?


I'll start by explaining a little about myself so that you might better understand the situation I am now facing because of this rule. Back in March I had a face-to-face assessment at my home with an Atos doctor. It was a tense and anxious wait for the brown envelope because the assessment is a lottery. No one can predict what their decision will be. When the dreaded letter finally arrived in the middle of May I didn't even realise it was the decision. Nowhere did it refer to a decision, or contain words such as, "we have made a decision" or "you have been placed in the work related activity group", or any reference to the assessment at all. What they did send was a leaflet about appealing a job seekers allowance decision. Confused? Yes! It took two phone calls and a week to find out what it was they were telling me.

In the meantime, I received a letter from my local job centre demanding that I attend a work related interview at a date in the near future or lose my benefits. I say local, but it's not the job centre in my own town, but a bigger one nearby in a busy shopping centre. My problem is that I have agoraphobia. I haven't been able to walk into that place in over a decade. I couldn't go there even if someone trusted went with me. I'm also terrified of telephone calls and speaking with people I don't know. I get worked up into an anxious panic, my mind becomes blank, I can't think, I feel unreal and floaty and words won't come. I also get panicked speaking to my own family and friends on the telephone, but that's another matter. The point is, I suffer from severe anxiety. I can't just have a nice meal out, take a trip or a pleasant walk down the street, go shopping on my own, get a haircut, meet new people, sit and socialise comfortably, attend family celebrations (and funerals) and sit with the family around the table at Christmas. I don't want sympathy, I just want to emphasise that if I can't do all of the ordinary and enjoyable things in life, then how can I be expected to suddenly overcome my agoraphobia and anxiety and jump through hoops for the job centre? All of this was explained in thorough detail in the assessment forms, and what a demoralising depressing experience describing it was too. There were lots and lots of letters and reports included from the multitude of mental health team workers who have tried, and failed to cure me over the last fifteen years as proof that I was genuinely diagnosed and struggling to cope with anxiety on a daily basis.

I really didn't feel able to speak to the job centre adviser when they called, but I had no choice. Not knowing what to expect I was brave and listened to what she had to tell me. She was referring me to the work programme and if I didn't attend I would be sanctioned. She asked if I had a mortgage or paid rent. "No". It has been suggested that the job centre have targets for sanctions and I have been set up.

All of this has happened so quickly that my claim was still within the four week time period to make an appeal for the support group. What troubles me most is that I am now receiving nonsensical and threatening letters from A4E and the job centre to arrange a work experience placement even though I still had time to make my mind up whether to appeal or not. I will tell you that I have now sent in an appeal form. This had to be requested and posted to me, and I will also tell you that it does not contain any advice or reference about how to appeal an employment and allowance decision or even where to post it. Are they making this difficult on purpose? You have to wonder?

I think it's cruel to harass someone who isn't fit to work and who can't get out of the house without a great deal of support to attend a work placement when it's simply impossible. I have barely slept and I'm experiencing a lot of horrible anxiety symptoms. Rather than helping me they are making my condition much worse. I don't want to imagine the horrors of having a massive panic attack in a public place with strangers around. Last time that happened in a work environment, I spent the afternoon in A&E.

You also have to wonder if the government is simply denying that sickness and mental illness exists, unless you're so ill or disabled that you're bed bound or in a hospital. If time limiting ESA to 365 days doesn't get you, because you have a partner who will not only be expected to care for you if you haven't recovered quickly enough, but they'll be 100% responsible for supporting you too and you won't have this marvellous tailored support to get you back to work (a blessing). You will find yourself sick and with no independent income or state support whatsoever. If you don't have a partner, or your household has been means tested and found to be dirt poor, the constant harassment and never ending stress might force you to attempt to live off thin air, kindly relatives or just simply throw in the towel for good.

The work programme claims to support sick and disabled people into work. Politicians like to boast that it helps to find lots of jobs for this difficult group of people who face massive barriers to getting into the work place. It is failing miserably. Out of the 80,720 people on employment and support allowance who were attached to a work placement, 1,290 actually ended up with a 'job outcome'.*

There is no way that I can mentally or physically attend this work programme placement whatever they have planned for me. If I can't function in a supermarket or shop or any place unless my mother is with me at all times, how can I be expected to work there? At the moment I am ignoring the letters because I can't cope with them. I am now waiting for the one that tells me my benefit has been stopped.

*http://ilegal.org.uk/thread/7123/work-programme-working

Song Of Life - Work Capability Assessments Cause Suffering

Work Capability Assessments cause suffering for the mentally ill

People suffering from mental health problems are often the most vulnerable when seeking help. Mental health can have a major impact on work, housing, relationships and finances. The Work Capability Assessments (WCA) thus present a particular challenge to those suffering mental illness. The mentally ill also are often the least able to present their case. Staff involved in assessments lack sufficient expertise or training to understand mental health issues and how they affect capability.


...It is a sobering statistic that 1 in 4 of us will experience a mental health problem in any given year. It is often quoted, but it is not a cliché; it is based on sound evidence obtained from several studies.

The impact of mental health problems are often exacerbated by the social and economic environment. Periodic hospitalisation may have impact on housing and jobs and on maintaining contacts in the community. All these problems can create instability. It is a time when help within the community can be of greatest benefit to maintain that stability. Financial problems can be acute because of periodic or long term inability to work. Financial help is a vital part of care in the community, enabling people with mental health problems to lead as stable life as possible.

The government should think again about the way in which WCA has been set up and is operating...

 Written by Ray Noble. Read the full post at Song of Life