The Psychiatry SHO*

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.