impact of welfare reform on mental health

Government’s Welfare Changes

Dr Simon Duffy ￭ The Centre for Welfare Reform ￭ Inside Government Conference, London ￭ 24th October 2012 ￭

What will be the impact on people with mental health problems?

You can call anything a ‘reform’ but it doesn’t make it so.

Key points

1.Changes will increase injustice

2.Mental health will further deteriorate

3.All caused by “Politics As Usual”

4.How do we change our thinking?

What are the changes?

• End of Disability Living Allowance• Cuts in Housing Benefit & Council Tax benefit• Reductions in Access to Work• Reduced eligibility for ESA• Increasingly intrusive testing by ATOS• Introduction of Universal Credit• Benefits reindexed to increase poverty• End of Independent Living Fund• Increased eligibility for social care• Increasing bureaucracy in social care• Reducing budget levels in social care• Return people to institutions and care homes• Increasing social care charges• Increased taxes, e.g. VAT, Council tax• and many, many other measures

[Source: HM Treasury, 2010 October Spending Review]

Some big growth and some big cuts

Biggest growth is in central spending

Big cuts to benefits and social care

What will be impact?

Mental health will deteriorate as

1.Inequality increases

2.Targeting causes stigma

3.As real poverty increases

4.As mental health services increase

Income inequality correlated with mental illness

45% of people in debt have mental health problems compared to 14% of people who are not in debt

Developing unmanageable debt is associated with an 8.4% risk of developing a mental health problem compared to 6.3% for people without financial problems (i.e. a third higher)

Relative risks for people in debt: alcoholism (2x), drug addiction (4x), suicidal ideation (2x)

Martin Knapp, 2012 Tizard Lecture

Some of this may be caused by practical aspects of poverty, e.g. debt:

Some of this may be caused by psychological aspects of poverty, e.g. stigma:

Chick Collins on the ‘Scottish Effect’

By 2015 benefits - will be cut by more than £18 billion, local government in England will be cut by £11.3 billion. 50% of local government spending is on social care for disabled people.

58% of all cuts target disabled people and people in poverty

36% of all cuts target disabled people

24% of all cuts target those who need social care - 1.9% of the population

Current cuts will target and further stigmatise particular groups, e.g. disabled people

WomenCentre in Halifax

at the front line

Mental illness one of many inter-locking problems

Managing a serious health condition 64%

Finding a safer place to live 27%

Living with childhood abuse 51%

Didn’t finish their education 76%

Recent experience of domestic violence 85%

Fractured family (for those with young families) 66%

Children experienced abuse (for those with children) 55%

Living with a severe level of mental illness 55%

Living with some mental illness 91%

History of drug or alcohol misuse 52%

Victim of crime 41%

Perpetrator of crimes 39%

Worried by debt or lack of money 65%

Of 44 women working with WomenCentre:

Service label N Urgent need N Real need N

Victim of domestic violence 55 Debt 50 Better self-esteem 64

Mentally Ill 39 Housing 48 To overcome past trauma 54

Criminal 35 Benefits 46 To manage current trauma 51

Poor Mother 33 Health 37 To stop being bullied 50

Misuses Alcohol 24 Rent 32 Guidance 50

Uses Drugs 22 Criminal Justice Advocate 24 Relationship skills 45

Violent 19 Dentistry 8 Mothering skills 26

Chronic Health Condition 16 Others 3 Others 1

The multiple reinforcing erosion of personal resilience

Our hypothesis - poor mental health is linked to real poverty.

These findings [better long-term outcomes for schizophrenia in developing countries] still generate some professional contention and disbelief, as they challenge outdated assumptions that generally people do not recover from schizophrenia and that outcomes for western treatments and rehabilitation must be superior. However, these results have proven to be remarkably robust, on the basis of international replications and 15-25 year follow-up studies. Explanations for this phenomenon are still at the hypothesis level, but include:

1. greater inclusion or retained social integration in the community in developing countries, so that the person retains a role or status in the society

2. involvement in traditional healing rituals, reaffirming community inclusion and solidarity

3. availability of a valued work role that can be adapted to a lower level of functioning

4. availability of an extended kinship or communal network, so that family tension and burden are diffused, and there is often less negatively 'expressed emotion' in the family

Dr Alan Rosen from Destigmatising day-to-day practices: What Can Developed Countries learn from Developing Countries? World Psychiatry 2006, 5: 21-24

Rather than reducing inequalities itself, the initiatives aimed at tackling health or social problems are nearly always attempts to break the links between socio-economic disadvantage and the problems it produces. The unstated hope is that people - particularly the poor - can carry on in the same circumstances, but will somehow no longer succumb to mental illness, teenage pregnancy, educational failure or drugs.

Wilkinson & Pickett, The Spirit Level

Reforming mental health

Q: Why is this happening?

A: Politics As Usual (PAU)

Possible explanations include:

Existing patterns of prejudice and stigma

Fragmentation of advocacy groups

Dependency of charity sector on government

Complexity of welfare system

Ignorance about our rights

Pandering to key electoral groups

Corruption or lobbying by profit-making groups

We don’t understand the truth

Money is really recycled to the middle

Current crisis framed by need to

Protect the ‘middle’ - the swing voter

Disguise the cause - i.e. house price inflation

Find scapegoats - poor, disabled people etc.

Protect popular items - e.g. NHS & Pensions

Seek favour from sponsors (corporate bodies)

What can we do?

Four possible responses

1.Challenge - don’t accept lies

2.Connect - use each other better

3.Campaign - argue for an alternative

4.Create - develop real solutions

Lure the tiger from the mountain

Never directly attack a well-entrenched opponent. Instead lure him away from his stronghold and separate him from his source of strength

From The Secret Art of War - 36 Strategies

Connect and rebuild

It is easy to talk about cooperation, but in reality we are in our current mess because it is hard to connect, develop shared interests and overcome jealousies and conflicts.

But, if we are not building, we are destroying

1. Human Rights - Better fundamental legislation

2. Clear Entitlements - Its ‘my budget’

3. Avoid Crisis - Family support, lower thresholds

4. Full Access - No ‘special’ funding for services

5. Choice & Control - Freedom, capacity

6. Fair Incomes - Enough for citizenship

7. Fair Taxes - No ‘special taxes’, no charges

8. Sustainability - Rethink health/social care split

The Centre for Welfare Reform

• Welfare state is good - it is just designed wrong.

• Move away from meritocratic thinking, instead value human diversity & equality

• New thinking must promote justice, citizenship, family & community.

• Innovate to build practical alternatives

You can get much more information on all these topics FREE at

www.centreforwelfarereform.org

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These slides are © Simon Duffy 2012 ￭ Publisher is The Centre for

Welfare Reform ￭ Slides can be distributed subject to conditions

set out at www.centreforwelfarereform.org