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Employment Must Not Be the Aim of Mental Health Treatment

04/07/2016 10:13 | Updated 04 July 2016

Therapy is about reducing suffering, right? Living a fuller life? Not according to current moves to place employment as a central aim of therapy. How come this move is so damaging? Why will so many of us activists and therapists be protesting outside the New Savoy conference on Tuesday, the conference that hopes to set the agenda for the next wave of mental health reform?

In recent years, the government has started to use psychology to get people off benefits, and back to work. In 2006 an economist, Lord Layard, published The Depression Report, an attempt to justify a new wave of therapy for the masses through cost-benefit analysis, the argument the government would actually save money in the long term. Though in many ways a brilliant strategic move, the coupling of saving money with mental health outcomes has become acceptable in a way we would not see with, for example, cancer treatment. We do not, would not, hear that chemotherapy is worth funding because it helps the public purse through getting people back to work. The emphasis is rather on quality of life and the reduction of suffering, precisely the kind of outcomes mental health service users are most interested in. Yet these ideas are not challenged in mental health because of the ongoing link between mental distress and moral failure, or failure to have sufficient willpower.

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In 2010, the government began to introduce a new wave of policies for benefits claimants, including those with disabilities. These are based on a psychological principle called behaviourism - punish people who don't do what you want, and give rewards to people who do. This carrot and stick policy took the form of taking benefits away from people who didn't or couldn't meet the government's requirements that the disabled should be work-ready, with a positive, psychological mindset.

The disabled began to report threats, explicit and implicit, that they would be sanctioned if they didn't go along to therapy to change their mindsets, or take courses based on cognitive-behavioural principles to gain the appropriate attitude. There is little choice here for benefits recipients, who would lose their means to eat, to have a roof over their head, if they didn't comply. It is difficult to emphasise enough how maddening this is. It is like being forced to act as if "everything is awesome" when the actual situation is one where there are few jobs, and where the jobs that are available are often deeply damaging based on inhumane practices such as zero-hours contracts and dire working conditions.

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As a result, partially, of our protests, the therapy umbrella organisations have promised to ensure that benefits recipients will have a choice of whether to start a therapy, free from risk of sanction. Yet we will carry on with our protest on Tuesday, for the reassurances neglect a core psychological truth. Our sense of ourselves and our worth is constantly being re-evaluated and shaped by the messages that we receive in our environment. The new emphasis on work as a treatment for mental health problems seen in 2009's Rand Report, and present in pilots across the country, places benefit recipients in an environment where work is constructed as an Ideal, the aim of a productive life. This chips away at the value of other activities, such as voluntary work, which are often more realistic for those with mental health problems, where capacity often fluctuates on a day-to-day basis. But more, it carries with it an insidious message that worklessness is worthlessness.

Denying the inability of many to work, and the lack of meaningful jobs, places the fault within the individual, who is likely to experience an exacerbation of despair, anxiety and depression. The drip, drip, drip of psychological ideas of causality here - so-called psychocentrism - is unlikely even to save money as it is one reason behind the massive surge of mental illness in the UK. If we feel the problem is in our head, we are unlikely to pursue the political action needed to effect change.

This new ideology not only compounds a culture of blame where the individual feels at fault, but allows politicians to present themselves as providing the answer, rather than part causing the problem. This is a deeply political act in a time when even a mainstream psychiatrist would privilege solving housing, employment and legal problems over traditional treatment.

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The casualties of this new ideology are unlikely to find room to talk elsewhere, free from the pernicious, shaping messages that employment is the only real health outcome of worth. For plunging much-needed therapy money into these projects will inevitably take it away from therapy services located where they should be - in organisations where the goals of therapy can freely be decided by the person who really matters, the person suffering.

By following the money uncritically, by ignoring the damaging side effects of psychology-speak, by cherry-picking the studies which fit with their own ideology at the expense of other literatures, psychologists risk worsening the existing mental health crisis. We call on delegates at the New Savoy conference to stand back from the interests of the powerful, in the service of those most battered and bruised by modern society.

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