CBT in Job Centres: Five Objections

In March, Nick Clegg announced his plan to improve access to mental health care for people who are out of work. It started off so well, but had a bizarre twist.

He said that he’d found an extra £25 million for mental health, to be invested over the next three years. So far so good.

And that this money might end up helping 40,000 people. Great.

And that this money would fund ‘specialists in mental health support’ to provide talking therapy in 350 Job Centres across the UK. Sorry, what?

On the face of it, you might mistake this for a good idea. Unemployed people are statistically more likely than average to have a mental health problem, and CBT can be pretty effective.

But there are at least 5 reasons why this is a disastrous plan:

  • It feeds into the belief that people with physical health problems should get better but people with mental health problems should get back to work. You won’t be seeing 350 new physiotherapists in Job Centres trying to get people with back pain back to work, even though back pain is a hugely significant cause of sickness absence. This is because we know that recovery comes first, is the primary goal, and happens in a recovery-focused setting, not a Job Centre, where the intentions of those doing the ‘treating’ become murkier.
  • There were already brewing concerns that people with mental health problems would feel coerced into accepting such treatments when the Tories simply came out and said it in their manifesto – some people will lose their benefits if they say no. This baulks against the very fundamentals of medical ethics, of being able to make an uninfluenced decision about what treatment to accept. Furthermore, doing therapy with people who simply don’t want to be there is at best a waste of money and at worst downright harmful.
  • It targets help at people who have something to offer in return, i.e. getting back to work and paying some tax. This is firmly against the principles of the NHS, which state that a person’s means (including, if you have any common sense, their potential) should have no say in their access to treatment. People with equally troublesome mental health problems but no likelihood of ever working again won’t see a penny of this £25 million.
  • What on earth are ‘specialists in mental health support’? According to these contracts for over 80% of the £25 million they appear to be online CBT assistants. These types of resources can be valuable and effective, but working in isolation, as I presume these guys will be, could be unsafe and result in downright quackery. Mental health conditions are complex and require a commensurate amount of assessment – not a quick meeting with someone who is barely qualified. Is there a chance that sub-standard assessments could diagnose problems where there are none, or worse, conclude that not being able to get back into work is a CBT-suitable problem in itself? This is a hair’s breadth from seeing unemployment as illness.
  • Despite it being sold in some articles as ‘co-location’ (i.e. multiple services working closely together in the same place), I can only see this project fragmenting services even further. It will simply add another layer of complexity and miscommunication to pathways which are already needlessly arcane and soul-destroying. Put it this way – the ‘specialist in mental health support’ isn’t going to be ringing the GP or psychiatrist with a thorough summary of treatment and progress, are they? If you want joined up services, put more employment advisors in mental health settings. Fund OT and social work better.

Clegg has been a positive figure for mental health in recent years, so I can’t be too harsh on him. But if he wants people with mental health conditions to recover and get back to work, my suggestion is simple. Fund mental health services better. Don’t create a coercive, work-orientated, untried, discriminatory and disconnected treatment model staffed by isolated and weakly trained staff.

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