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.

Here Comes Everybody: Basic Income, the Precariat and beyond

Last month, when releasing a report showing that 100,000 children went hungry in Britain in 2014 because their parents’ benefits were stopped or cut, Niall Cooper, chief executive of pressure group Church Action on Poverty, made a simple yet devastating analogy.

“If you commit a crime, no court is allowed to make you go hungry as a punishment. But if you’re late for an appointment at the Job Centre they can remove all your income and leave you unable to feed you or your family for weeks,” he said.

In fact, there is evidence of people stealing in order to be sent to prison and guaranteed three meals a day.

This is the most urgent justification of a basic income. More than 900,000 people in Britain used the food banks of just one provider, the Trussell Trust, in 2013-14 and the most common reasons were benefit sanctions or benefit delays. Always cruel, many of the reasons are arbitrary and absurd. So there is a critical need, you could even call it a demand, for an unconditional income floor – an income that cannot be whisked away at a moment’s notice, at the whim of a bureaucrat with a target to meet. Everyone has their basic subsistence covered. Period.

That seems to be the rationale behind the UK Green Party’s “long term aspiration” for a basic income of £3,700 a year. And while the Greens are mulling it over, 19 well-known economists, including Guy Standing, have called on the European Central Bank to introduce an unconditional income of €175 a month (€2,100 a year), as an alternative to alleged economic stimulus of quantitative easing. Similarly, the Spanish anti-austerity party, Podemos, wants an unconditional income for the unemployed, though like the UK Greens, Podemos is committed, in principle, to a basic income.

Obviously, no-one can live on €2,100 a year, or £3,700 for that matter. These are policies for unconditional income support, rather than a liveable basic income. But they are edging their way towards a minimum income for everyone. For argument’s sake, let’s put the level at £7,000 pa. As one American supporter of basic income writes. “Without an income floor set at the poverty level as a bare minimum, I believe poverty and inequality will continue to grow, the middle classes will continue to shrink, and the livelihoods of all but the top fifth of society will continue to slip away.”

This is one kind of basic income. An income floor for the increasingly numerous precariat. 13.5 million people in Britain live on incomes at or below 60% of the median, which is about £21,000.

But there is another kind of basic income and it has far more ambitious horizons. The Swiss 

Generation Basic Income group who will spearhead a referendum campaign for the introduction of a basic income in Switzerland in 2016, want it to be much more than a subsistence fall-back. They are calling for it to be set at 2,500 Swiss francs a month, the equivalent of £20,000 or US$ 30,000. Another advocate of an unconditional income, the Australian trade union organiser, Godfrey Moase, sets the bar at AUD$30,000 (about £15,000). A universal basic income is not just for the precariat, says Generation Basic Income’s Enno Schmidt, it is for everyone. It is not a product of class struggle, he insists, it does not exclude the rich.

Each kind of basic income obviates the problems thrown up by the other kind, though in turn generates new issues.

To take the first sort of income floor basic income. Though few can doubt its necessity, the intrinsic problem with this kind of unconditional income it that it is only relevant for the bottom 30 or 40% of society – people who can’t get enough hours to support themselves or their dependants, the working poor or unemployed, adults in education or simply those who would gladly trade a stressful job for substantially less money but the freedom to choose the life they want.

The dilemma this variant of basic income provokes is that you can easily imagine it inculcating a reverse politics of envy. The excluded two-thirds or 60% of society will feel they are financially carrying the lucky minority who have the freedom not to work, or work less, and devote themselves to freely chosen pursuits. Astonishingly, this inverted politics of envy is already being avidly stoked in Britain by the Conservatives and their ‘strivers v shirkers’ rhetoric. A basic income would probably elevate this sentiment to astronomical proportions. Once introduced, it is conceivable that a basic income would engender an exodus of people from the world of work to the Saturday morning world of unconditional income. But that would still leave a resentful 50% with the perception of an even greater burden and the pressure from the other side to raise the basic income. Although you can foresee a new social dispensation taking shape, there would be immense social strife in the meantime.

The other, more ambitious, kind of basic income avoids stirring up envious feelings. Set at a much higher level, it is overtly an unconditional income for everybody. “Basic income doesn’t exclude,” says Enno Schmidt. “It’s about humans.” It is clear that the social problems that have prompted an interest in an unconditional income are not restricted to the precariat. Anxiety and depression are rampant across social classes and a sense of powerlessness and control by outside forces affects people with full-time, well paid jobs as much as those on the fringes. “Who, experiencing for years the daily toll of intense corporate pressure, could truly escape severe anxiety?” wrote Alan Lightman in his 2001 novel, The Diagnosis.

Beyond the issue of how to pay for this kind of unconditional income (which I will come to in part 3), two questions arise. One is why pay a basic income to rich people, or people with moderate but secure incomes for that matter, and secondly, what exactly would they do with it if they received such an income? The frequent justification for a basic income that it represents a new attitude to work and would act as a balm for feelings of stress, burn-out and anxiety. “We’re facing a shift of the paradigm of what work means to us, and it is this generation who is ready to express this shift”, said Marilola Wili of Generation Basic Income in 2013.

The fact that a basic income would be paid to all adults, not households, means that, set at a generous level, it would certainly enable those that wished to, to swap their jobs for less demanding ones, or pack in work altogether. But for those that didn’t choose those options, a basic income would just mean the amassing of a lot of additional money. Maybe the possibility of escape represented by the mere existence of a basic income, would engender a seismic change in the culture of work. That could be one effect, but it’s also possible that the repercussions of introducing a basic income would be much more modest than its advocates envisage.

Pilot studies in basic income undertaken in the US and Canada in the 1970s indicate that participants responded by only slightly reducing their working hours.  Such findings have been used to assuage fears that, with the introduction of a basic income, industrial civilisation would grind to a halt and everyone would sit around, doing nothing. But another conclusion is also possible – why go to all the trouble of introducing a basic income if the results are so meagre?

Because in the real world society we inhabit, it is a neo-classical fiction that, even with a basic income to fall back on, people in employment would have the choice to reduce their working hours. They could leave their jobs, certainly, or maybe switch to a less demanding job, or become self-employed. Within households, one partner may leave their job while the better-paid one stays on. But it is my hunch that many would people make the decision to stay in their jobs, working similar hours, and so the only palpable effect of a basic income for many would be to supply a large extra income. You could argue this would reduce inequality but it also has the potential to be funnelled into buying property, stoking an even bigger housing bubble than the one we have now.

I think here we can see the limitations of what a basic income can do. Basic income is not the same thing as Bertrand Russell's 'organised diminution of work'. It can immeasurably strengthen the hand of the individual as they negotiate with the world of the work. That feature should not be underestimated. But in choosing to leave what goes on in that world untouched, basic income reveals itself as impotent in dealing with the ‘daily toll of intense corporate pressure’. Many institutions, in pursuing targets or profits or simply impact of some kind, are now intensely oblivious to the welfare of the people that populate them. And, ironically, I can sense in basic income the same reluctance to challenge the behaviour of large institutions and the distribution of property and profits that used to be exhibited by welfare state leftism – the very movement whose demise is giving such momentum to the movement for a basic income. On its own, a basic income is not enough to really change society.

In part 3, I want to look at the ways in which a basic income might be funded, and whether that can be done in an equitable, not acrimonious, way.

Here is the first part

And part three