Catching up on the news and I came across this item
. I originally came across a shortened version of it elsewhere which caused the mercury to rise and a bit of anglo-saxon. But reading it in full does give food for thought. I do like the statement "economic house arrest", catchy, pithy and designed to grab one's attention. It also sets the scene for arguing in favour of privatisation of welfare services to 'release' these poor trapped souls into the warm sunlight of the work environment.
I agree that there are people who skive and use the system but, I am not entirely sure about the figures Freud quotes. I have no ideological concerns about using the private sector to run this system, if and when it is up and running. I do have concerns about the incentives and bonuses to get people back to work. People with mild - moderate depression can get back to work with the right level of support, guidance and the empathic understanding of those tasked to get them back to work. That is the crunch...from the written proposal outlined by Freud to the actual everyday practice, well, that sends a shiver down my spine. Who decides what is a 'genuine' illness if not the GP's or other doctors? What work will there be available...A* level burger flipping? What level of support will there be for someone who becomes ill during the proposed initial three year process of working? Certainly from my experience of supporting people with severe and enduring mental illness in dealing with the benefits system, the automaton on the other side of the counter who is
encouraged to meet targets and get anyone back to any job is a worrying indicator of things to come.
My concern is the impact of ill thought out and poorly implemented practices upon the poor sods caught in the middle of all of this. The people who are severely mentally ill will undoubtedly be 'fast-tracked' through the process and remain on benefits. However, the process itself may impact upon the health of those individuals. The small group of fraudsters and skivers may be rooted out in time and I can only applaud any impact upon these parasites. But what about those individuals who would like to work but whose mental health problems make returning to work difficult? I'll give an example from my practice many years ago in a large conurbation (who said sociology teaches you nothing!) many miles from here. All anonymised and confidentiality maintained, etc...
Middle-aged artisan, happily married and works hard. Unbeknownst to all around him, he suffers from anxiety and drinks secretly to cope with meeting people and going out and about. He has the mother of breakdowns and eventually comes the way of the local mental health team via a stay in the local MH unit. The secret is out, family and friends know about his anxiety, depression and alcohol problems. What we and his wife know but others don't is that he hears voices when he is anxious. The voices are derogatory, command him to do things and often tell him to kill himself. He is physically fit, the medication and psychological strategies we give him help to manage the anxieties. He returns to work but once again he struggles to cope with the pressures of work and demands made of him. He hides it for a while but he then breaks down and refuses to leave his house. He lost his job after shouting at other workers because he believed they were orchestrating a whispering campaign and it was their voices he heard. He hits the bottle again and it takes a lot of work on our part and his family to help him regain some equilibrium. This happens on and off for two years and eventually he accepts that he needs a long break from work. He has savings and uses those to survive on but he eventually agrees to sign up for benefits. He is ashamed to be on benefits after working for over 30 years but he is not able to work. After a further two years, he is doing voluntary work and he is training to work with animals. He is called in to see the local jobcentre and with the support of the disability officer, ourselves, etc...he takes on a part-time job similar to his previous one because he has the skills and he is keen to work again. He hates being a 'burden' and despite the concerns of ourselves and his family, he is working again. It goes well until some number crunching desk jockey without an ounce of wit amends his benefits...Incapacity benefit is stopped. The man decides to increase his work hours because he has no money and the desk jockey has written stating he is not entitled to it, etc... Luckily the paramedics and police intervened and patched him up after he attempted to kill himself because the voices returned following the stress of working, again in the same environment that precipitated it in the first episode. He was diagnosed with depression and anxiety; then the diagnosis changed to schizoaffective disorder; it was changed several times depending upon the presentation and the psychiatrist whom he saw. Happily, I discovered a few years later that the man is working with animals, he is happy and his life has changed for the better.
My concerns with the new system, when it is implemented, will be the desk jockeys who analyse and interpret the sum total of an individuals life and mental health problems. I expect to get busier than ever when as a result of target and bonus driven private companies the number of breakdowns rise.
By the way, I say when the system is implemented because companies are already recruiting nurses to these jobs to vet the long-term sick. Nurses are cheaper than doctors...