When does crude electioneering become a threat to public health? Rishi Sunak’s and Mel Stride’s relentless attack on disabled people, with a specific targeting of mental health claimants, will have damaging and potentially deadly consequences. Those of us working in acute psychiatric wards and community services can attest to the severe impact their suggestion of stopping disability benefits would have, and the pain caused by the callous manner in which they have delegitimised mental anguish.
Sunak has accused the benefits system of “medicalising the everyday challenges and anxieties of life”. Stride, the secretary of state for work and pensions, has labelled depression and anxiety as conditions potentially unworthy of welfare. He proposes vouchers, one-off grants and improved access to treatment and support as alternatives to cash benefits. This approach not only complicates the process with additional bureaucratic hurdles, but also insinuates that long-term needs can be addressed with temporary solutions, which is not feasible.
Implied in this policy proposal is the idea that people with anxiety or depression are often claiming deceitfully. With this rhetoric, Stride is playing a well-worn card, dividing a few worthy victims who deserve our support from the majority who, it is implied, are “abusing the system”. Here, claimants with “mild” mental health conditions are depicted by Stride as either pretending to be disabled, or having been deluded by a modern cult of mental illness such that they refuse to cope with the “ups and downs” of life. I speak from experience when I say that politicians propagating these obscenely simplistic and false narratives have the potential to drive vulnerable patients to self-harm and increased suicidal tendencies. They can also trigger acute episodes.
To understand why, we need to know two things: one about personal independence payment (Pip), and the other about mental illness. Pip, the target of the latest attack, is a benefit given because disability demonstrably increases living costs. As Pip helps with these costs, it acts as a lifeline by providing claimants with the means to function. It has nothing to do with sicknotes or unemployment benefits, but the Tories have taken to discussing all three together – a smoke-and-mirrors tactic that plays to base fears of undeserving “skivers” draining us of essential resources and taking an undue chunk of the pie.
Depression and anxiety make easy targets for Stride because he is playing off existing prejudices that sufferers face. This is the view that clinical anxiety is akin to the nerves one might feel before a party or an exam, and that depression is passing sadness, rather than inescapable horror and emptiness. The implication – that one should be able to overcome these problems with sufficient willpower – is nothing less than disability denial. Delegitimising these conditions matters hugely and there is clear proof: the rate of male suicide in this country has been steadily declining over the past decades, largely because depression has been reshaped as something serious and deserving of help.
In 2019, there were an average of about 2,200 new Pip awards a month in England and Wales where the main condition was anxiety and depression – last year, that number more than doubled to 5,300 a month. This increase is neither simply a result of greater mental health awareness, nor “snowflake” culture for that matter, but rather because those diagnoses are the speakable ways of labelling the very real impact on body and psyche resulting from hardship, a pandemic and a lack of opportunity. It is then made all the worse by the Tories’ demolition of the mental health infrastructure that is needed to recover.
Stride sells us a story where individuals just rock up at their GP surgery and offer up a few symptoms they’ve Googled. Then, with their diagnosis in hand, they are given thousands of pounds a month. This couldn’t be more of a misrepresentation of how hellish the process of claiming Pip often is. No one gets Pip for any specific condition, whether that’s depression, cancer or back pain. Not only does Pip require a high level of disability with frequent assessments and a barrage of professional evidence required, but it is awarded on functionality, not diagnosis. Someone with a diagnosis of schizophrenia may have no ongoing daily disability and therefore not be eligible, while someone with debilitating anxiety might require a carer to be present not only to leave the home but to prepare food, and therefore receive Pip.
Pip can be a traumatising benefit, instilling a constant fear of reassessment in its recipients. “It’s the sword of Damocles. It just hangs there and hangs there and you never know when it’s going to fall on you,” one claimant put it. That threat is now even greater thanks to the government’s proposed reforms. Some of my patients often have to decide between whether to “heat or eat”, with only the few hundred pounds that Pip provides to mitigate the increased costs associated with their disabilities. Why are they being attacked?
This government’s “moral mission” to reform welfare is an attempt to blame on individuals a problem that can only be explained systemically. The rising disability bill is not down to duplicitous claimants, but widespread and disastrous cuts that have left our mental health services emaciated and failing. It’s an obvious point to make, but the severity of mental health waiting times only exacerbates conditions such as depression and anxiety, and runs contrary to the fundamental principle of medicine that early intervention reduces long-term complications. Rather than an honest assessment of their own failures, all the Tories can do is blame sufferers. It is a grotesque distortion that callously sacrifices vulnerable people for political gain.
Jay Watts is a clinical psychologist, psychotherapist and senior lecturer working in London
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