Tuesday, 8 December 2015

Why does British society generate so much mental illness?

If a list were to be made of the recent British government policies responsible for inflicting the greatest suffering on the domestic population, the Work Capability Assessment (WCA) would surely emerge as undisputed table-topper. The tick-box test, introduced by the last Labour government in 2008, to determine whether people are ‘fit for work’ and thus eligible for benefit or not, has spread an atmosphere of dread among the sick and disabled people subjected to it.

The WCA has generated a morbid parade of destroyed lives and the disappearance of hundreds of  thousands of people, estimated to be 30% of those found’ fit for work’, into the netherworld of not working, or claiming any benefits. Destitution, in plain language.

One group, though, have proved particularly vulnerable – those with mental health problems. Around half of those subject to a WCA have a mental health condition. Last month, researchers linked the WCA, or simply the threat of it, to 590 suicides and more than 700,000 anti-depressant prescriptions. Psychiatrists have blamed the test for causing relapses in patients with severe mental health problems. Even ‘passing’ a WCA and being declared ‘unfit for work’ doesn’t stop people being hounded. There has been 668% rise in the last three years in Employment and Support Allowance claimants (i.e. those considered too ill to work) with a mental health condition being sanctioned.

But quietly unnoticed is that the WCA is not working even under its own brutal terms. The test was an example of ‘austerity, before austerity’. In the 2006 green paper on welfare reform, then work and pensions secretary, John Hutton, promised the WCA would save taxpayers up to £7 billion a year. Despite seven years of culling and sanctioning, this hasn’t materialised. The Office of Budget Responsibility estimates that spending on incapacity benefits will rise from £13.4 billion in 2013/14 to £14.5 billion in 2018/19. Overall, ‘welfare’ spending is also set to increase, says the OBR.

Mental illness epidemic

But amid a benefits systems that seems to be doing its level best to make mental health problems worse rather than better, we need to ask a simple, though easily overlooked question – why is this society, British society, generating so much mental illness in the first place?

Because as fast as the DWP can declare people fit for work or sanction them, new claims are made. According to the OECD, 40% of new disability benefit claims in Britain are because of mental health problems, the highest proportion among all 34 member countries. The latest figures indicate that 48% of Employment and Support Allowance claims are for ‘behavioural and mental disorders’.

It is a question our political rulers are oblivious to. The Conservatives respond to the mental illness epidemic by mooting forced treatment. The opposition parties espouse a more compassionate approach but settle on superficial ‘talking cures’ such as cognitive behavioural therapy. And they still cling to the Work Capability Assessment*, which has caused so much suffering and distress. In the case of the Liberal Democrats and non-Corbyn Labour, they also still cling to austerity.

Austerity and social security cuts are a production line for the very mental health problems the political class claims it wants to reduce. The Centre for Welfare Reform has blamed policies such as the bedroom tax for ‘savaging’ people’s mental health. The group ‘Psychologists Against Austerity’ has identified ‘austerity ailments’, such as humiliation, insecurity and powerlessness; all experiences that “lead to mental distress”.

Even the staid OECD have concluded you have to look deeper in order to stem the torrent of mental illness. According to the OECD’s Shruti Singh, ‘job strain’, bad line managers and long hours’ are all “detrimental to workers’ mental health”.

But far from being alleviated, ‘job strain’ is being intensified. In 2014, researchers from Cambridge University found zero hour contracts were just the ‘tip of the iceberg’ of flexible employment practices causing widespread anxiety, stress and ‘depressed mental states’.

Extreme part-time contracts, where workers must work overtime to survive, ‘flexi-contracts’ which don’t provide sufficient hours to make a living, and key-time contracts where employees are given limited core hours and forced to state additional hours they can work, are inflicting suffering on ‘huge numbers’ of workers, researchers from the university’s department of sociology said.

These are “all experienced as a form of job insecurity that causes untold stress for thousands of employees and their families,” they concluded.

Evidence is conclusive that job insecurity and lack of job control is lethal to both physical and mental health. Research featured in the 2009 book The Spirit Level that tracked Whitehall civil servants of varying grades demonstrated how low job status was related to heart disease, cancer, gastrointestinal disease as well as depression, suicide and sickness absence from work.

Mental distress is socially caused

It is here that a deliberate blindness on the part of ruling elites needs to be exploited. As the writer Mark Fisher has argued, the dominant way of thinking simply cannot concede the social causation of mental illness. Debate is strictly limited to a fight between ‘hawks’ who want to crack down on the financial burden of the psychologically distressed claiming state benefits and ‘doves’ who wish to reduce stigma and increase access to alleged therapies such as CBT. The extreme prevalence of mental illness is assumed to be an unfortunate accident of individual brain chemistry and genetics.

But curiosity in this regard can be subversive. We need to vastly expand our horizon of what engenders mental health and the factors that lead to its opposite. A genuine attempt to reduce mental health problems needs to start by fundamentally de-stressing the workplace, enhancing the condition and stability of housing and removing the ever-present dread of income being snatched away.

This is just a start. Successfully combating mental ill-health is dependent on creating a less unequal, more socially just and less stressful society. Radical political changes such as worker self-directed enterprises, a basic income and a huge expansion of social housing, need to come to the fore. Coincidentally, these are precisely the political directions we should be going in anyway.

In the 1950s, the famous German psychoanalyst, Erich Fromm, advocated concentrating our energies on creating a ‘sane society’. It is an aspiration that needs reviving.

*The Work Capability Assessment is a classic example of the extremism of the political centre. The WCA was created by the Labour party in 2008, and, in fact, the proportion of people left destitute after being found ‘fit for work’ following an assessment was higher under Labour - 55% - than under the subsequent Conservative/Lib Dem coalition, when it was estimated to stand at 30%. The Conservatives, upon assuming power in 2010, embraced the WCA with gusto and extended it to existing Incapacity Benefit claimants. Under Labour it was had merely been used on new claimants but had Labour won the 2010 election, they, too, would have extended it in the same fashion. The Liberal Democrats, as dutiful coalition partners, supported the WCA.

These actions were all undertaken by political parties scrambling to be regarded as centrist. Labour, under Blair and Brown, coveted the fabled ‘centre ground’ of politics. George Osborne claimed in October that the Conservatives had created a ‘new centre ground’. The Lib Dems, have always presented themselves as neither Left nor Right, but centrist.

Still, none of the main political parties have come out against the WCA. The Conservatives swear by it, the Lib Dems promised a review at this year’s general election, and Labour, under Corbyn, has so far only committed itself to a ‘complete overhaul’, not abolition. Likewise the SNP went into the last election pledging an overhaul of the WCA. Although a working group established by the Scottish government did recommend the WCA be scrapped in an independent Scotland.

The only parties firmly committed to abolishing the WCA are outside the mainstream – the Greens, and even UKIP, yes them, amazingly enough.


  1. You are obviously right to return to this theme - and particularly to stress the refusal of our mainstream parties to address it. This seems to be reflected in Corbyn's choice of an obscure Brownite as shadow WP secretary, rather than a heavyweight like Diane Abbott, which one might have expected given the furore over benefit cuts.

    Depressing as this is I feel change may be at hand. There is growing awareness of the glaringly obvious link between attempts to marginalise the most vulnerable through WCA and other symptoms of austerity (on the one hand) and massive social dysfunction and breakdown on the other - e.g. the epidemic of domestic violence and child abuse that even Cameron seems to have noticed (if only because the police are now obviously far too stretched to cope with it). The Right, as you suggest, are in principle quite happy with this situation, but many of the "centrist" equivocators are evidently more worried. To judge from a recent outbreak of interest in universal Basic Income - including the RSA and New Economics Foundation (which have hitherto kept incredibly quiet about it) - and ever more mentions in the media (inc BBC Newsnight) many in the mainstream, who see Universal Credit as the unworkable monstrosity that it is while adequately remunerative employment becomes a pipe dream for ever more millions, are starting to see the need for a more radical solution. In this context any slightly intelligent human being must see BI as a no brainer:



  2. More evidence of how part-time, insecure work lies at the heart of record employment levels. The number of men in low paid, part-time work has increased 4 fold in the last 20 years: http://www.bbc.co.uk/news/business-38603722 - http://www.bbc.co.uk/news/business-38603722

    'men who previously worked in low-paid but secure, full-time jobs in sectors such as manufacturing,' says the report's author, 'have lost that type of employment'

    Such a decline in status and conditions is bound to have an affect on mental health