As a retired GP who spent 35 years looking after people with anxiety and depression in primary care, I find Rishi Sunak’s recent comments about GPs “over-medicalising the everyday challenges and worries of life” offensive (Sunak to cite Britain’s ‘sicknote culture’ in bid to overhaul fit note system, 19 April). These disabling problems constitute around 40% of all those attending a GP practice.
He clearly has no idea what is going on in his country. People are suffering from multiple stresses, including huge financial pressures largely brought about by his own party’s total incompetence over the past 14 years. People are pretty resilient when dealing with stressful adverse events such as bereavement or job loss or debt in their lives, but when they encounter one more bad thing, they “hit a wall” and become unable to continue. It seems like a hard-wired mechanism that renders them incapable of carrying on.
Often, all they need is to step back from the edge and take a short break, which is where the GP role is central as the provider of the “fit note” and some compassionate emotional support. The GP will assess the level of distress and may offer signposting to debt advice or mental health services, which of course have been cut to the bone. Frequently people wait many weeks or months even to admit to the shame that they are too unwell to work, and keep on trying relentlessly and just getting worse.
The suggestion that some “specialist work and health professionals” would be perfectly able to keep them slogging away at work regardless is ridiculous. Even more unlikely is the suggestion that “tailored support” would be provided.
I find insulting the suggestion that GPs are unable to be “objective” about assessing their patients and that some minimally skilled “other” following an algorithm will magically whisk them into recovery. It is laughable, ill informed and may tragically drive some people to suicide. Of course, if I was being extremely cynical, I would acknowledge that dead people do not claim sick pay.
Dr Maureen Tilford
London
• I would like to tell Rishi Sunak about the application that my mentally ill sister made for personal independence payment (Pip) in 2017 while living in her own home on anti-psychotic medication and under a mental health services care order (Sunak accused of making mental illness ‘another front in the culture wars’, 19 April).
Despite this, the application was rejected as lacking sufficient evidence. The assessors had targets to turn down claimants, so they had to reject a proportion of their cases, irrespective of merit, and this was clearly a case of need. But there were no targets to turn down appeals. My sister’s case was accepted on appeal, on much the same evidence. The process took eight months from the first claim, and was backdated in full.
But I had to call the Department for Work and Pensions to tell them that the letter informing my despairing and financially destitute sister that she had been entitled to Pip all along had arrived three weeks after she had taken her own life. I heard the horror in the DWP worker’s voice when I told her, for she was the one who had both rejected the original claim and accepted the appeal.
I believed then, as now, that had the state actually cared about those in need rather than looked for ways to strike down claims by hook or by crook, it could have given my sister the will to go on. My sister was one of many. Sunak wants to ramp up this practice. It can only lead to more suffering, and more deaths.
Mark Lewinski-Grende
Swaffham Prior, Cambridgeshire
• Rishi Sunak’s entry into the Tory war against those on disability benefits is the latest in a long line of attacks that routinely undermine many people with long-term conditions whose health and capabilities will never improve. My wife suffered traumatic brain and other physical injuries in a road traffic accident in 1982. Under a Tory government in the 1990s, the then Department of Social Security confirmed her benefits on a lifetime adjudication.
Under the post-2010 Tory government, they have been subject to regular review. She lost the enhanced rate of Pip in 2018 because it was deemed that she could plan and undertake a journey. I love her dearly, but she cannot plan her way out of a paper bag.
Name and address supplied
• If Rishi Sunak wants to tackle the “sicknote culture” and reduce the number of those joining queues for mental health services, he has a simple cure at his disposal. He only needs to resign, call a general election and make way for a more competent and caring administration. The national mood would rise by leaps and bounds, and millions of people would immediately feel better at the prospect of light, however faint, at the end of our current endlessly dark tunnel.
Maggie Black
Oxford
• Rishi Sunak’s speech last week claimed that we are overmedicalising the ordinary ups and downs of life, with people leveraging psychiatric labels and sicknotes to avoid working. His solution for both people and services is to toughen up, by raising the bar for receiving sick leave and health support. The explicit aim is to reduce the disability bill, NHS waiting lists and costly absenteeism. The covert aim is to deny that high levels of debilitating mental distress exist in Britain, and that this distress is rooted in social causes that need to be addressed.
The research into the social determinants of poor mental health is comprehensive, demonstrating that rising mental health problems are inextricably linked to the contexts in which people live and work. As a recent World Health Organization report shows, worsening workplace mental health is being driven by social factors such as wage inequality, excessive workloads, low job control and job insecurity, workplace demoralisation and dissatisfaction.
So yes, rising distress may not be a medical problem, as Sunak claims, but it is certainly a social one, as Sunak ignores.
We need to stop overmedicalising mental distress. As a psychological therapist, I know first-hand that most people seeking help aren’t suffering from “mental illnesses” in any biologically verifiable sense, but from understandable reactions to life and work conditions that are harming and holding them back; conditions that medicine was never designed to treat. By misrepresenting socially caused distress as a medical issue, we run the risk of wrongly individualising, pathologising and ultimately depoliticising that distress, and so exonerating social conditions from responsibility.
Overmedicalisation is indeed a problem, but not for the reasons Sunak thinks.
Dr James Davies
Associate professor of psychology and medical anthropology, University of Roehampton; author of Sedated: How Modern Capitalism Created Our Mental Health Crisis
• In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or you can email jo@samaritans.org or jo@samaritans.ie. In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org, or text HOME to 741741 to connect with a crisis counselor. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
