Starving you back to work: Why Tory policy of cutting benefits if you refuse treatment is vile

The Tory manifesto it out. Like many others I was immediately drawn to page 28, where David Cameron explains how he will ‘help you back into work if you have a long-term yet treatable condition‘. But their spellchecker must be on the blink because they obviously don’t mean ‘help’, they mean ‘threaten’.

‘We will review how best to support those suffering from long-term yet treatable conditions, such as drug or alcohol addiction, or obesity, back into work. People who might benefit from treatment should get the medical help they need so they can return to work. If they refuse a recommended treatment, we will review whether their benefits should be reduced’

The idea of starving sick people back to work was first raised by the Tories last year, but despite the fact that it went down like a sack of lead crap, they’ve stuck with it.

I viscerally object to this policy in so many ways it’s hard to know where to begin.

Firstly, it only seems to target people who have an illness or condition that they can (mistakenly) be blamed for. Cameron won’t be threatening poorly-controlled diabetics with benefit cuts if they don’t take their insulin, and he won’t be nagging people to attend their physiotherapy following a stroke. He’ll only be threatening people who he thinks, from his ivory tower, chose to become ill. This shows just how ignorant the Tories are when it comes to difficulties like addiction, obesity and mental health problems. People with these problems hardly ever choose to be that way. The causes of their suffering are often as external to them as any ‘physical health’ problem – poor housing, employment, lack of affordable healthy food. But Cameron thinks their difficulties are a lifestyle choice, and this is sheer discrimination. He wants people with physical health problems to return to health, but people with mental health problems to return to work.

Secondly, it is hideously naive of the Tories to assume that change is easy for people with these conditions. It isn’t, and there are good reasons for that. Therapy for a mental health problem can be an emotional pressure cooker, and medications all have side effects. I assume that losing weight when you can afford only the cheapest, most unhealthy foods is pretty difficult too. Any kind of help for these problems requires insight and motivation, which can take years of careful mental and social preparation. To force someone into treatment too soon using the threat of financial penalties actually risks wasting money and might actually make people worse. As an aside, I’ve never done therapy with or prescribed a tablet to someone who had to accept it or they’d lose their benefits, and I wouldn’t want to. It’s not a great place to start a therapeutic relationship and sits in stark opposition to good medical ethics.

Finally, the fundamental ethos of this policy sickens me. A caring government, who want a ‘brighter, more secure future’ and a ‘good life for all’, would create a society in which people wanted to take up treatment of their own accord. They would provide adequate services to provide that treatment and explore the reasons why people might be struggling to accept it, instead of cutting services to the bone then denying it). They would fix the root causes of social problems like obesity and addiction. But instead, we have a government who delight in the use of the stick over the carrot, placing unfortunate individuals as solely to blame for complex conditions then punishing them for not taking up treatment for which they probably aren’t ready.

The incentive for recovering from a mental health problem or addiction should be recovery itself, not starvation from benefit cuts. This policy needs to be scrapped, and quickly.

About Alex Langford
I am a psychiatrist (now an SpR) based in Oxford after 3 years working in South East London. Before I went into psychiatry, I used to be a general medical doctor, and I also have a BSc in psychology. I'm particularly interested in improving the public face of psychiatry, evidence based medicine, teaching and patient rights. Don't mention cricket unless you've got the next fortnight free to discuss it.

22 Responses to Starving you back to work: Why Tory policy of cutting benefits if you refuse treatment is vile

  1. Alex written so well and spot on. I know many SUs who want to work and work full time as they have that ability and that is great however for those unable to work due to illness it should not be something that is out of the dark ages again. My local joint commissioner went to JCP to talk to advisers there about SMI and how to support people also those with depression etc. He said the only word to describe the experience was treacle. Thank goodness we have common sense in doctors like yourself however the politicians need shooting.

  2. I wonder why they even want to be able to use the “refuses medical treatment” excuse since they don’t seem to have had any trouble finding excuses to ‘help’ people without it:

    “Cameron won’t be threatening poorly-controlled diabetics with benefit cuts if they don’t take their insulin”

    Perhaps not. For sanity’s sake I hope not.

  3. Pingback: Starving you back to work: Why Tory policy of cutting benefits if you refuse treatment is vile | Britain Isn't Eating

  4. Zeno says:

    Excellent. See also Dr Margaret McCartney’s take on this: The tory manifesto – stigma in action

  5. Sally says:

    Well said!

    Also needing consideration are the NHS treatments that patients view as harmful and entirely detrimental to their health. The case of ME where the current recommended treatment is Graded Exercise Therapy, would be a good example. There is now ample evidence that this is very harmful to at least a subset of patients – some patient’s have been rendered permanently bedbound by following this regime. What compensation will they then receive if they were forced to undertake this therapy?

    • Sasson Hann says:

      Yes, I picked up on the fact that the policy isn’t just aimed at obesity, alcoholism or MH problems but also any ‘long-term condition’ that is supposedly ‘treatable’.

      I refused a 2 day a week programme (mornings in the GYM; afternoons in lectures given my pain deniers, oops pain specialists) for my as yet undiagnosed condition that is M.E./M.S. like because I could barely attend one hour a week. 5 years ago, the psychologist of the Rhemy department blocked any further access to the clinic unless I agreed to attend. True to his word, when muscle deterioration brought about the dislocation of my knee cartilages a few years back, so that I couldn’t walk, my GP referred me, but the appointment I received 2 weeks later had a covering sheet entitled: ‘What to expect in your PSYCHOLOGY appointment’!!!

      That aside, I really fear being forced onto these dangerous treatments. I told the psychologist at the Rhemy department that I would be seriously ill after a few hours there, but he was adamant that his programme made people LESS disabled. I said that people as sick as me wouldn’t possibly be able to attend, so his research in the area was skewed. I told him of the 5000 peer reviewed studies concerning the physical root of M.E. like illnesses, some proving that many sufferers have heart failure due to the fatigue, so exercise could be extremely dangers. He said HIS researched superseded ALL other research.

      This is what frightens many people with chronic conditions, that they’ll be forced into therapies that are not only damaging but could actually lead to a loss of life or make life intolerable.

      • Bill Kruse says:

        I doubt if they’ll try to kill you, though they won’t be bothered if you do die as it’ll make their figures look good, another ‘positive outcome’ for them. What they will try to do though is make life on benefits so unbearable you’ll stop claiming.

  6. I’m both fat and mentally ill – I have bipolar disorder. I don’t work; I had an experience of serious bullying while working for a government department, and took early severance because I decided I couldn’t cope with it. I now live on a small civil service pension.

    I’ve tried to lose weight on many occasions. I’ve even succeeded – for a short time. It has never worked long term. I gather from what I’ve read that this is not uncommon. Most diets do not work long term, a secret the dieting industry is anxious to keep from their customers. Further, many of my friends are fat or overweight, and I’ve never known a diet work for any of them, either. Data from long term weight loss studies bears out my experience.

    I also had a long argument with a very young doctor on this subject – during which it appeared that I was very much more widely read on the subject than he was. But you’d expect that – being fat and in my 50s, I’ve a lifetime interest in reading about weight loss studies and more time to have read them. He was a slim young recently minted doctor and while he knew something about the subject, I’m sure it was of no more than passing interest for him.

    I’ve been on at least eight serious diets during my lifetime, and am now fatter than ever. This, too, is not uncommon.

    For what it’s worth, I found low carbohydrate diets worked best for me, even though they give dieticians the professional heebies. Low fat diets were the most difficult, and resulted in me having suicidal ideation within three to four weeks, and were therefore unsustainable. Suggestions such as ‘use a smaller plate’ are, frankly, stupid. All that happens is that I put the same amount of food on the plate.

    I’ve given you something about my background and experience to explain why, in my opinion, the idea that obesity is in some way treatable, is misleading. What the Conservatives actually mean is that they don’t like fat people, and feel that they are lying about on benefits.

    If someone is fat enough that their obesity is the reason for them not working (I was a fat person and worked just fine for 26 years before being bullied out of my job because of my mental illness) there is something else going on with them, not just their weight, and maybe that thing needs to be addressed.

  7. Bill Kruse says:

    This has nothing to do with helping anyone except the Tories helping themselves to the country’s assets. Less for us, more for them is how it works so anyone they can pretend to the gullible ignorant public would be perfectly well if only they’d accept the available phony baloney treatment will lose their benefits when they ‘fail to engage’ with the local witch doctor or whichever smirking overpaid charlatans the Tories delegate performing this ‘treatment’ to.

  8. Aside from the ethics, there’s the simply practical question: where are all these therapists going to come from?

    My money is the ‘help’ turning out to be nothing more than CCBT, administered by A4E etc. rather than by medical professionals. Win-win for the DWP: mandate something inappropriate and ineffective, and when people don’t make use of it, you can sanction them and list them under ‘skivers’.

  9. Lucy says:

    Just how many people are “cured” of MH conditions. It’s horribly cruel, how will they assess improvement in a condition? What actual treatment is available that works and isn’t founded in that awful, reductionist crap of CBT? Answer – none. So it will be “take the pills/ect/cbt” or starve.

  10. emovoid says:

    Great post. This Tory policy also raises issues of consent and bodily autonomy. Many medications and treatments have side-effects, so the patient might have legitimate reasons for not agreeing with the “recommended” form of treatment. What if the recommended course of treatment was something extremely controversial and invasive like electroshock therapy? It is horrifying to think that someone with mental health issues could be effectively forced into such a treatment out of economic necessity.

    I’ve just written an at-a-glance guide to the manifesto promises all the main parties have made on mental health – please check it out.

  11. Pingback: Starving you back to work: Why Tory policy of cutting benefits if you refuse treatment is vile | ladybirdabroad: one year with agricultural and cocoa growing communities in Ghana

  12. abetternhs says:

    Reblogged this on A Better NHS and commented:
    Really important blog by Alex Langford. Worth reading with this paper about patient perceptions on patient-centred care and quality improvement:

  13. Pingback: CBT in Job Centres: Five Objections | The Psychiatry SHO*

  14. Sunny says:

    We can now look forward to fun politics where clients (like me) make life interesting by saying that they’re entitled to tackle their obesity therefore they want to stop taking their antipsychotics and mood stabilisers shown to cause weight gain, and rely just on talking treatments. Naturally this may work for some, but a course of brief cbt-ish stuff by a quickly-trained person risks sending the client away significantly worse mentally than when they arrived, especially if they’re having a relapse following abrupt withdrawal of their meds. But maybe that’s what’s wanted when the claimant talks gobbledygook or tries to hang themselves in the loo, the quick-fixers can sanction their benefits for non-compliance. I was concerned as to whether I might be delusional again, but thanks to reality-checking with many others, I can say with confidence that IDS and his mates are slimy toads.

  15. Pingback: On politics: idealism and inaction | Dream Electric

  16. elspethc says:

    Well written. Keep going, now those of us who try to get to grips with distress and its multiple causes have a long spell in opposition. Do you agree that ‘starvation’, including the emotional or ideological kind, leads to mental states of polarised simplistic need (can’t call it thought), where fundamentalist views become attractive? This is the way I explain recent political events to myself, otherwise I am saying silly cliches like ‘turkeys always vote for Christmas’. I do not believe people are stupid, more that in these defensive states they need better care.

    • Thanks for the comment. You might have put it more poetically than me, but if what you’re saying is that people are more likely to vote for benefit sanctions (etc) if they lose an emotional connection with those suffering from them, then yes, I agree. This is why a free press and social media is important.

      • elspethc says:

        Yes this happens – but I meant also that those who are discriminated against and thus suffer, may then defend themselves by denial projection etc so that they are less able to reach more thoughtful assessment of what is on offer. They are more likely to seek illusion – the Ideology, the Religion the Someone Knows (capitals necessary) seem to offer comfort even when the real world gets worse – maybe the process is analogous to those abused can become abusers?

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