In October, the government once again delayed the implementation of so-called Personal Independence Payments (PIPs), the replacement for Disability Living Allowance (DLA), saying it had not been able to carry out enough assessments. PIP is part of the latest attempt by successive governments to cut benefits – already at almost subsistence levels – to people with disabilities and introduce draconian checks on whether claimants are ‘really’ disabled.
Such discrimination and contempt is particularly severe for people whose disabilities are caused by a mental health problem. Mental health problems can be as debilitating as any physical illness and are equally exacerbated by difficult economic or social circumstances such as poverty, isolation, poor housing or inappropriate work. Mental health problems are more common among poorer people in general and already oppressed groups such as black people, migrants and the LGBT community.
Cuts to health care and disability benefits disproportionately affect people with mental health problems. More than 1,500 mental health beds have closed over the last two years. The NHS has spent millions shipping vulnerable people in need of acute care hundreds of miles away to private hospitals. There are documented cases of desperate patients killing themselves after spending days failing to access a bed in a psychiatric unit. Meanwhile, services such as drop-in centres providing support, rehabilitation, housing and employment advice have seen funding slashed. While mental health problems account for 40% of illnesses in Britain, it receives 13% of NHS funds. Funding for mental health services fell 1% in 2012-2013 – a loss in real terms of around £150m – on top of a 1% fall in 2011-2012. Despite talking therapies approved by the National Institute of Health and Care Excellence proving both successful and cost-effective, the flagship Improving Access to Psychological Therapies programme has stalled, with only 500 of a needed 800 therapists being trained and funding for vital patient appointments cut by up to 30%.
The infamous Work Capability Assessments (WCA) used to determine if someone is eligible for sickness benefits are worse than useless in assessing mental health. The WCAs are humiliating, asking intrusive, personal and often irrelevant questions. They focus overwhelmingly on physical indicators and take no account of fluctuations – very common in mental health – in each individual’s ability to cope, or the difference between forcing yourself to do something once and doing it every day. Many people speak of it taking them hours to get ready to leave the house for the WCA and days to recover. Yet ironically the very act of turning up then renders them fit for work in the eyes of the assessors and thus not entitled to benefits! A recent survey revealed that six per cent of all GPs (approximately 2,000) had known a patient attempt suicide as a result of an Atos assessment.
The failings of the WCA are made clear by the fact that so many appeals, particularly in mental health cases, succeed – around 40%. However, the appeal process itself involves a long wait, with benefits kept at the same below-subsistence rate as Jobseeker’s Allowance throughout this time. Appeals are held by a tribunal, usually in the intimidating setting of a courtroom. This can be particularly stressful for people with mental health problems, many of whom will have experienced mistreatment by the police and misunderstanding by the justice system. People ‘acting strangely’ are more often taken into police custody than offered appropriate care. Young black men with mental health issues – such as Roger Sylvester and Sean Rigg – are more likely to be taken to a ‘place of safety’ that is in fact a police cell and subjected to inappropriate restraints. Approximately half of all the 954 deaths in police custody since 1990 have been of people with mental health problems; the figure rises to 61% of deaths in state custody overall, including those detained under the Mental Health Act. Black people make up over a third of that figure.
There is no set ‘cure’ for most mental health problems. The glib assertion by the government that people get better through work is false when that work is isolated, repetitive and badly paid, which is the reality for the majority of working class people, particularly those who have long periods of sickness. A combination of approaches, some of which require expensive one-to-one therapy by experts, is often the only solution. Even common problems such as depression or anxiety require personalised therapy. The capitalist state has proved unwilling to fund this, instead handing out vast numbers of prescriptions for drugs, which may or may not be suitable for the individual, but are of course far cheaper than funding talking treatments or tackling the practical factors – poverty, job insecurity, discrimination, loneliness, neglect or abuse – that make people ill in the first place or exacerbate their condition.
Over the decades, the state has preferred to rely instead on ever-cheaper, one-size-fits-all solutions: the old-style asylums until the 1960s; chemical coshes such as valium in the 1970s; over-prescription of anti-psychotic drugs and institutionalised patients placed on under-funded ‘care in the community’ schemes from the 1980s; under-tested new anti-depressants from the 1990s.
People with poor mental health are an oppressed group under capitalism. The majority of people experiencing mental health problems struggle to access treatment and support while experiencing ongoing stigma and discrimination. Groups like Disabled People Against Cuts have shown a way forward in empowering people to fight against discrimination and for ‘full human rights and equality’. This struggle should be placed clearly within the wider fight for decent health funding and against cuts, poverty, racism and oppression. Within any movement to overthrow this rotten system, disabled people, including those who have experienced mental health problems, like other oppressed minorities, will play a significant part.
Sam McDonald
Fight Racism! Fight Imperialism! 236 December 2013/January 2014
