I’ve made some bad choices in my life. When I was younger I had terrible taste in men. There was the verbally abusive guy who ran off with his internet girlfriend (but not before selling off my treasured comic book collection), the guy with a fetish for medieval dental tools. Each time, I gathered my strength and chose to leave.
A few years ago, all choice was taken away from me. I was beaten up, raped and almost killed by someone I knew. I survived, but was left withpost-traumatic stress disorder, anxiety disorder, depression and OCD. Due to a lack of treatment – there are lengthy waiting times for treatment on the NHS – I’ve also developed social phobia. I’ve been waiting for more than a year for one-on-one sessions with a psychologist and I know I will have to wait at least a few months longer.
Perhaps, then, I should welcome a new government initiative to combine mental health treatment with job support. According to government estimates, about 260,000 people claiming employment and support allowance (ESA) have mental health problems. As is typical of the Department for Work and Pensions, however, its latest scheme is ill thought-out. For while current trials are voluntary, the aim is to make treatment mandatory – refuse and you’ll lose your benefits.
And that’s the problem. I’ve made some bad choices in life, but they were mine to make. It should also be my choice – as it should be anyone’s – who I open up to about my experiences and when I consider myself ready to do so. Reliving a rape, for example, is a traumatic process that can unsettle the fine mental balance a person has worked hard to achieve. It can’t be rushed, and should not be subject to the threat of losing what little support and stability one has available. The choice between treatment or losing your benefits is no choice. A loss of benefits can mean debt, homelessness and starvation. That is not a future anyone should have to face, mental health problems or not.
The pilot scheme is voluntary. How volunteers are able to reflect the success (or lack thereof) that the programme would have with non-volunteers is just one of the concerns I have about this latest idea. Where will all the mental health experts necessary for treating 260,000 ESA claimants come from? How qualified are they? How long will the treatment be available for? What happens when a person’s mental health does not improve at a rate that is agreeable? Will they be sanctioned? How can a person be expected to feel less anxious and less depressed when they are living with the fear of losing their benefits?
Mental health is complex. There is no magic cure. Some people may require only short-term treatment, while others may need long-term help and some will always need medication or professional support, or both. While it is unclear what form the offered treatment will take, a government source who has spoken in support of the scheme has praised the success rate of cognitive behavioural therapy (CBT). Other suggested treatment options include online support, group work, and third-party telephone-based psychological and employment-related support.
This may be helpful to some, especially those who suffer from less severe anxiety and depression, and whose anxiety and depression is not tied to other conditions. I’m not denying that. And don’t get me wrong: I want mental healthcare to improve. I want it to be available for everyone who needs it. The current waiting lists are ridiculously long and mental health is woefully underfunded. The issue is with the link between treatment and benefits, and with the catch-all approach. CBT has its limitations. People with deep-seated mental health problems are in need of an individual approach, with an individual treatment plan.
Right now, a person cannot be forced to undergo treatment unless they are considered a risk to their own health and safety or that of others. Forced treatment flies in the way of medical ethics, but then, ethical considerations towards people with physical and mental health problems have long ago been thrown out of the window by this government.
The disastrous, punitive actions towards those who are the least capable of fighting their corner are inhumane, and I am left with no choice but to condemn them.
