Note: the rather marvellous Kate Belgrave is a campaigning journalist with whom we and MHNE have been working. She is indefatigable, principled, informed and a bit sweary in this reposted blogpost. So, you have been warned…
Here is another update from life on the social security cuts scene and a few thoughts from myself…
This time – mental health.
Below you will read about the sort of shit that continues to go down for people who are fighting cuts and/or having to live them while their union-baron and Labour saviours fanny about with Falkirk…newspapers full of all of that this week and nothing on the sort of story you’ll read below. I can’t stand that shit. I really can’t. Fantastic union members and activists all over are working round the clock to fight privatisation and massive job and service cuts and all we get to see on the news at the moment is shot after shot of Len McCluskley and Ed Miliband playing Biggest Penis. That’s leadership for you in a time of crisis. I really hope something extraordinary results from the Falkirk washout – something, perhaps, like a consensus on the reasons why Labour didn’t repeal Thatcher’s draconian anti-strike legislation during the party’s 13 years in power – a move that would have made it more possible (or less impossible, at least) for the “ordinary people” who everyone is suddenly so terribly concerned about to defend their jobs and salaries from Tory destruction.
Whatever. What would I know. What I do know is that while all that leg-lifting and dickswinging goes on, ordinary people and ordinary families deal with situations like this one I’m about to bitch about. This has all been happening while Falkirk has been happening. The difference is that nobody at that end of things gives a fuck.
I was (life being cute) returning from a meeting with Newcastle mental health service users and workers when I read about the DWP’s latest wheeze: the department had been granted leave to appeal the recent Upper Tribunal decision on its responsibilities to ESA claimants with mental health conditions. You may recall that this action against the DWP was brought by the Mental Health Resistance Network last year. Two claimants represented by the Public Law Project argued that Atos work capability assessments discriminated against people with mental health conditions.
As the Public Law Project’s Ravi Low-Beer told me here, the claimants wanted reasonable adjustments made to work capability assessments and the onus put on DWP to source medical evidence for ESA claimants who had mental health conditions at the start of their ESA claims. Not everyone who has a mental health condition is always in a position to source their material, said Low-Beer: “Conditions fluctuate in seriousness, or [people] cannot easily talk about their disability.” That meant people could be found fit for work without their whole medical histories being taken into account.
The courts agreed – but it seems that is too bloody bad, as usual. The DWP wants the decision overturned: “we disagreed with the Upper Tribunal’s original ruling,” the department told me this week, via an email that I felt like kicking through my laptop, “and are pleased that the Court of Appeal has given us permission to appeal.”
So. Isn’t that fantastic. No matter that the change may improve things even slightly for people who must go through the dreadful work capability “process.” No matter that the change may have improved things as far as the public purse goes – people found eligible for ESA from the start when they should be would not, obviously, need to take their case to wildly oversubscribed, increasingly costly, tribunal appeals. Even some of our biggest rightwing wankers could surely see the attraction of that.
But no. “We believe we have made – and continue to make – significant improvements to the work capability assessment process for people with mental health conditions,” the department blathered.
My answer to that – as it has been for a while now – is “prove it.”
I mean something quite specific by that, too. Because, you know – for the last eight or nine months or so, a group of mental health service users and support workers and I HAVE been trying to make the department prove that it has made improvements to WCAs for people with mental health illnesses.
As I have written elsewhere, me, and campaigners from the voluntary sector consortium group Mental Health Northeast (MHNE) and the Newcastle user-led mental health support group Launchpad have been trying in particular to make the department prove the effectiveness of so-called Atos Mental Function Champions (MFCs). What a caution this exercise has been.
For those who don’t know this hopeless story – MFCs were “introduced” into the ESA work capability assessment process, on a Malcolm Harrington recommendation, to “improve,” somehow, WCAs for people with mental health illnesses. MFCs would, according to Atos, “spread best practice and provide advice and coaching to healthcare professionals at any stage in a case” where an ESA claimant had a mental health illness, learning difficulty or cognitive impairment.
Last year in November, Mark Hoban told parliament that he’d introduced an MFC into every assessment centre in the country. Actually, he hadn’t. The DWP told us that there were 60 MFCs across the country and that they largely worked a phone advice line – to “provide advice and support to Atos assessors, spreading best practice, and building links with appropriate stakeholders in their area,” whatever the hell that meant. Since November last year, our group has tried and tried to find out exactly what that meant – how this MFC role works for people with mental health conditions and indeed if MFCs have “improved” assessments for them, and how anybody could tell.
This hasn’t gone well.
Our group has not been able to find any concrete evidence of performance measurements or reporting for the MFC role at all. Despite repeated requests, the DWP could not produce that information and finally admitted that Atos “did not report back to the DWP on things like that.”
This is extraordinary. The MFC role is an important formal concession that the DWP and Atos have made to the monumental concerns raised about the WCA experiences of people with mental health illnesses – but the DWP wasn’t formally monitoring it. ESA claimants did not see MFCs and were not assessed by them: MFCs were there to advise and support Atos assessors only. It’s all very well saying that MFCs were “a great resource” but how would anyone know that? How would the DWP? How would we? Let’s not forget that coroners and GPs have reported that people are committing suicide or attempting suicide because of their experiences with work capability assessments. I mean to say. Jesus Christ, you know. It doesn’t get much more serious than that.
In April, after months (six) of asking, MHNE and Launchpad managed to secure a meeting with the DWP and Atos in Newcastle. One of the two members of the Atos contingent was, it was said, an MFC. The DWP confirmed at the meeting that it didn’t formally collect data from Atos on MFC performance. Atos said that it kept records of calls to MFCs and logs of questions raised with MFCs by Atos assessors – but that it wasn’t prepared to make any of that information public. Which is entirely useless. What’s the point of this role if nobody can see whether it works or not, or what sort of questions Atos assessors are asking of people in it? How can people with mental health illnesses be reassured that their issues are being understood by their Atos assessor if they have no idea what sort of advice MFCs give, or what sort of questions Atos assessors ask MFCs before, during, or after assessments? How can anyone know what the fuck is happening, except the people who are in charge of the “process” and won’t tell anyone what they’re doing?
Other points of note/concern that came out of that meeting:
* Atos and the DWP were unable to provide any specific information on how MFCs were recruited (which seemed bizarre, given that one of the Atos representatives at the meeting was an MFC)
* MFCs are not required to have formal qualifications in mental health. The minimum requirement is that they have some postgraduate experience in mental health.
* To train for the MFC role, Atos HCPs take a two-day Atos inhouse self-facilitated training course.
Which takes me back to the start of all of this. It is GROSSLY unfair that the DWP would want to overturn a tribunal decision that would make claimants’ lives easier and fairer. Unfortunately, Fair isn’t the point of most policy exercises in this charming day and age. I’ve talked with quite a few people with severe mental health conditions in the last couple of years and Fair isn’t the word that comes to mind when they explain the things they have to deal with. Words like Throwing People Off Social Security At All Costs and Total Dismissal By The Political Class come to mind. I’ve talked with people who are dealing with cuts to support services, homelessness, the closure of their supported living hostels, their councils lying about finding them proper accommodation, community mental health teams being too overwhelmed to help and endless other shit that makes austerity so great. This is not, please, to say that I think people with mental health conditions are pathetic and hopeless and can’t function. It is quite the reverse. It is to say that I keep talking with people who tell me that back in the day – when they had reasonably secure housing, reasonably regular counselling, contact with supportive professionals and a bit of income, life was possible. As those things have gone, life has quickly become less possible.
“The first thing we try and do when someone is in crisis is to try and find them some sort of secure housing,” a northeast welfare rights advisor told me recently as she explained why people with mental health conditions were struggling – with benefit cuts, with preparing themselves and their paperwork for work capability assessments when they’d just been released from hospital and needed places to live and so on. “If you can get people into secure housing, you can start building things from there. They can have an address and they can have that stability.”
I can believe it. Here’s someone who didn’t have that stability – a guy called Pete Gyte*, who I spent several days with in Weymouth last year (I met him at the Soulfood kitchen, which serves free meals for people who are struggling for money). He’d been on and off the streets for some time as he battled the worst of his depression and drug and alcohol addiction.
“I actually went round to the council one morning,” he told me as we sat eating breakfast (DON’T TELL THE GLORIOUS LORD FREUD I GOT A FREE SLICE OF PEANUT BUTTER TOAST THERE PLUS ONE CUP OF TEA BECAUSE HE’LL THINK I WENT FOR THE FUCKIN FREEBIES HA HA HA), “because I was so done in from sleeping on the pier. It was chucking it down with rain – gale-force wind – and I only had 30 minutes’ sleep, because of the fucking generators going on the bastard ferry. I walked into the council and I said “why don’t you just take me to the hospital and give me a lethal injection?””
I’ve been to several work capability assessments now with people who have severe mental health conditions. One man – Stephen – had a long-term schizophrenia diagnoses. That diagnoses wasn’t mentioned in his final report (he challenged that fit-for-work decision and won on appeal. He went from zero points in his initial assessment to an placement in the support group at appeal. That’s how accurate and consistent this Atos rubbish is). “I do have suicidal thoughts and I get really depressed, but I usually manage to talk myself out of it. I tell people that I’m a member of society, but I feel on the fringes of it, as if I’m an outlaw and not in the mainstream. I do hallucinate [especially at night]…I see things like giant squid and things like that…I think I’m being eaten alive…. the drugs, the Sulpiride I take, it’s got quite bad side effects in that my limbs shake every night when I go to bed and keep me up half the night anyway. It has basically gone on since I was 18.”
Needless to say, Stephen’s most “productive” (surely the favourite word of the political class) years were the ones in which he had decent support.
“When I first got out of hospital, when I was 18, I was given a job by my dad, so that he could look after me day to day and see how I was doing.” He also did well at university, when onsite counsellors were regularly in touch, to make sure he was getting through his work okay. He says that support meant that he was able to finish his degree. But then the support fell away, so everything else did. “Since then, I have either worked part time, or gone into full time education, or basically been on training schemes, or been on the welfare state. The labelling [as someone with schizophrenia], stigmatises and discriminates against you in the minds of employers. I’m in my 50s anyway and that’s another thing against me…and what it has meant is huge great holes in my CV which have been covered by little bits of volunteering.”
Right at the moment, I’m speaking with Maggie, who also has a long-term schizophrenia diagnoses. She’s been on incapacity benefit, but has been told that she’ll be moved to ESA and will be called to an Atos face-to-face assessment.
She’s terrified of that assessment and has not had an easy history. ”I was diagnosed with schizophrenia in 1997. It’s hard to tell the difference between what’s real or in my head with paranoid schizophrenia. Seeing things that aren’t really there. Hearing voices in your head and things like that. Suspicious of what people are thinking. Not knowing what’s real and what’s not. I first had my breakdown when I was 21. I’m now on daily medication. I was sectioned in 1997.
“I go out shopping, but I don’t really like it. It is hard, going out. If you have schizophrenia, you see the world differently. You are very suspicious of people. So, it’s hard when I go out, but I force myself, because I think if I don’t go out, I’ll feel isolated and I won’t be able to cope with anything and deal with everyday life.”
She’s obviously concerned about the assessment and asked if it was true that people’s benefits could “just be cut off.” I’ve been in email contact with her and her partner again in the last week or so. On and on it goes. I can see where all this is heading. It won’t be long until some political worthy tells us that all anybody with conditions like severe depression or schizophrenia needs is a slap in the face and a few months of homelessness and then they’ll wake up to themselves. Cured. Fixed. It’s a miracle.
ON IT GOES.
But, you know – nobody who has the power to change these things gives a shit. So – let’s just devote some more time and endless column inches to the Len and Ed pissing contest and act like it’s all for the benefit of people in need. Let’s just make that the priority. Let’s pretend that Labour isn’t wedded to social security cuts and privatisation and that senior union officials – three years into these cuts – are suddenly of a mind to fight austerity. Let’s just do some more of that. Because that is really working for me.