Mental health workers protest at move to integrate clinic with jobcentre
Critics say plans for London clinic come dangerously close to government proposal to give psychological treatments to the unemployed
Friday 26 June 2015
The government wants therapists to help jobcentre staff assess and treat claimants, who may be referred to online CBT courses. Photograph: David Sillitoe/Guardian
Mental health workers and their clients marched on a jobcentre in south-west London in protest at a scheme they say frames unemployment as a psychological disorder.
The Department for Work and Pensions announced in March that Streatham’s jobcentre would be the first to have therapists giving mental health support to help unemployed people back into work.
The DWP has now said that announcement was a mistake. But by coincidence, next week Lambeth council will open a £1.9m mental health clinic in the same building.
Mental health workers and service users, furious at what they see as an attempt to embed psychological treatment in a back-to-work agenda, were to go ahead with their demonstration anyway.
They said they regarded Lambeth’s decision to locate the borough’s main community mental health centre in the same building as the jobcentre as being in the spirit of the plan to give psychological treatment to the unemployed.
Anger has been growing since the March budget announced a scheme to bring counsellors into jobcentres to offer “integrated employment and mental health support to claimants with common mental health conditions”.
Under the plan, therapists from the NHS’s Improving Access to Psychological Therapies (IAPT) programme would support jobcentre staff to assess and treat claimants, who may be referred to online cognitive behavioural therapy (CBT) courses.
According to a recent DWP reply to a Freedom of Information request, the therapists would provide “Nice [National Institute for Health and Care Excellence]-approved and evidence-based psychological therapies to treat people with depression and anxiety disorders”.
The letter from the DWP went on: “Given that confidential space to deliver therapy is available in Jobcentre Plus premises, IAPT services will be conducting assessments and face-to-face therapy sessions in jobcentres, in the same way that they are provided in other community settings.
“Supported online CBT will be conducted through computers, via instant messaging and video communication tools, and via telephone.”
Advocates point to the correlation between poverty and mental health problems and say helping people back to work could aid their recoveries. Offering therapy to people on benefits could help them deal with the worst psychological effects of joblessness, they say.
But critics say existing back-to-work policies, such as workfare, which forces people to work for their benefits, place people under psychological pressure, making jobcentres inappropriate venues for mental health treatment. Moreover, they are concerned that in an environment where there are few good jobs, individuals’ unemployment will be blamed on their own attitude.
The DWP has said claimants would not be sanctioned for refusing psychological treatment. But the Tory manifesto threatened benefit cuts for ill people who refused medical treatment that could help them back to work. In a hustings, Mark Harper, the minister for disabled people, suggested people with mental health conditions could be included.
Psychologist groups, including the British Psychological Society and the British Association for Behavioural and Cognitive Psychotherapies, have expressed concern that claimants will be forced into accepting interventions.
In a statement published on Thursday, the BABCP, which runs CBT training in the UK, said it was “against any offer of any treatment (including CBT) based on coercion or associated with unfair or disproportionate inducements”.
This month Prof Jamie Hacker Hughes, president of the BPS, pointed out recent research which presented evidence that claimants had been forced to accept psychological treatment. Researchers from Hubbub and Birkbeck, University of London, found unemployment was being rebranded as a psychological disorderin many advanced economies, with interventions being introduced to promote a positive outlook or leave claimants of welfare to face sanctions.
Dave Harper, a reader in clinical psychology at the University of East London, told the Guardian he believed there was an ideological agenda driving the government’s proposals.
“We are in a recession,” Harper said. “There are not many jobs out there and this is implying that unemployed people are to blame for their situation. It’s shifting the focus away from economic policy and on to the individual.”
Paul Atkinson, a psychotherapist based in London, was sceptical about the DWP’s claims that mental health treatment would not be linked to sanctions. “It’s part of the same project of encouraging people back to work, which has got the whole sanctions culture wrapped around it,” he said.
Not all mental health specialists oppose the scheme. Janet Weisz, chair of the UK Council of Psychotherapists, gave it a cautious approval. “In principle it’s good,” she said. “What we have concerns about is: what does this mean? Does something that’s an option become something more mandatory?”
Weisz said she was writing to the DWP for clarification on how the scheme would work. But she added: “The fact that we are writing to the DWP about how to deliver counselling and psychological services, that’s a concern. What I’m hoping is they will respond and have a dialogue with us.”
Critics said the government’s own pilot study of IAPT in jobcentres showed it was ineffective. The research by the Work Foundation found that of 413 people referred to the pilot scheme in four unnamed locations, 173 refused to take part. Many more dropped out. In the end, just 15 got jobs.
The DWP originally announced in a stakeholder bulletin that IAPT would be rolled out in jobcentres from this summer, beginning in Streatham. A DWP spokeswoman initially denied this, saying websites that had reported it had got it wrong. After being shown news of the scheme’s introduction on websites and online publications by DWP partners, a spokesman told the Guardian the announcement had been made in error.
An NHS spokeswoman said the Lambeth Living Well Hub, the new “front door” to a range of mental health services for patients from the borough, was not linked to the DWP scheme to install therapists in jobcentres.
“The jobcentre building was chosen as the location for the hub as there was free available office space and there was an opportunity to train jobcentre staff to help them work better with people with mental health issues,” a statement said.
Denise McKenna, an activist with the Mental Health Resistance network, one of the groups that called Friday’s demonstration, said she was horrified about effectively having to go to the jobcentre to access mental health treatment.
Cuts to mental health services had resulted in many people with quite serious mental health problems being discharged from their local mental health trusts and left in the care of their GPs, she said. These were the people likely to use the new centre.
“Can you imagine having to go to the jobcentre and talk about very intimate, personal things then having to leave through the office in floods of tears?” she asked.
Responding to the wider plans to embed mental health treatment in jobcentres, she added: “I can see someone at the jobcentre ending up very seriously injured by someone with mental health problems. God forbid it should ever happen, but it’s on the cards.”
Robert Dellar, a carer who also edits Southwark Mental Health News, a freesheet , said: “I’m here because the community mental health services team in Lambeth has been relocated to the same building as the job centre; because people with mental health problems are terrified of going anywhere near a job centre; because they are subjecting them to harassment.
“I think having the two things here will actually deter people who really need mental health services from approaching them. This will lead to more suicides. We are trying to put pressure on mental health services staff not to cooperate.”
Dellar didn’t have to go far to find mental health professionals who also oppose the scheme. Yards away, next to a large banner for Psychologists Against Austerity, stood Laura McGrath, a lecturer in mental health at the University of East London.
“We are concerned about pathologising unemployment and pathologising poverty, turning these structural problems of a slow economy into an individual problem, blaming people for conditions that are outside of their control,” she said. “The idea that psychological therapy could be used in tandem with sanctions is completely against what it’s about.”
Helen Lucas, from Wandsworth, southwest London lives with schizoaffective disorder, which means she suffered psychotic attacks on an almost daily basis. She said counselling and therapy were long-term treatments – in her case 30 years and counting – that were totally inappropriate in the context of the jobcentre.
“There’s already CBT (cognitive behavioural therapy) available on the NHS, in a confidential, private setting where I can trust them,” she said. “Why don’t they continue with that and cut the waiting time?”
Claire Truscott, from Herne Hill, southwest London said she was horrified at the proposals. “This government said that they wanted to see parity between mental health services and physical health services. Are they intending to treat broken legs down here?
“You should be referred to mental health services by your GP, not a Jobcentre.”
Credit: Guardian Newspaper.