Zero sum game

In what parallel universe could a man called Freud say that disability means you’re worth less? Guess that’s what happens when you put an ex-banker into a position of power in the Department for Work and Pensions. The bottom line for the UK’s health and welfare is a financial one. From the cost of absence to the lawyers'  fees at employment tribunals, its the business case not the moral one that counts. As a result, our whole mental health system is premised on getting people back to work, quickly. Nothing wrong with having a decent job to build the old ego, but the question is how do you do that when you find yourself in the not unusual situation of being dis-abled? In order to cut welfare and the costs to the UK economy of people getting sick, dis-ability got banned by the UK government to be replaced by a ruthless regime of positivity. We no longer ask what’s wrong, just what’s right.  Fitness became compulsory. Trouble is when you look at the figures, they don't add up. Figure 1: 25% of us will experience a serious mental health problem. This is a Conservative estimate if you believe that economic crisis and low wages might chip away at your self-esteem and increase your chances of experiencing prolonged despair. Figure 2: 90% of people with the most stigmatising diagnosis of schizophrenia will never work again. So serious the consequences of being given this diagnosis, psychiatrists avoid giving it for fear that they will obliterate their patients’ chances of earning a living ever again. Figure 3: In order to cut disability benefits by 20% the Work Capabilities Assessment was set up. This enviable job was outsourced to Atos, one of the biggest contractors in the UK operating in the not-so-public sector. One year later GPs reported that 21% of people put forward for an assessment of their fitness for work considered or attempted suicide.  You do the maths.  And before you think this is nothing to do with you because you’re not currently dis-abled think again, old chum. Coming soon to a workplace near you is the DWP’s new fitness assessment system. The National Health and Work Service aims to get people back into work quickly. The service will assess anyone likely to be off work longer than 4 weeks and will be delivered by a private company Maximus. This proudly named outsourcing company will be forced to play a perverse game of assessing people on the basis of the presence of  ‘fitness’ while avoiding eye contact with actual ‘sickness’. In the UK the number one cause of long term absence is mental illness with depression and anxiety in the top spots. You can therefore safely assume that the people sent for assessments will be treading the thin line between distress and despair. If you manage to convince a Maximus temp that you are not fit (presumably the easiest way to communicate that is to be unable to go through with the assessment) the question with no tick box is going to be how do you then get back to work? With mental health services in the UK in crisis due to massive levels of under-resourcing and with 75% of people getting no treatment for Mental Health Problems after visiting their GP how are people going to get better? The reality is that since 2008, sickness absence has consistently gone down. This is not just because everyone has officially become fit, its also something to do with the fact that we’re working in a climate of fear. Most of us are too scared to disclose mental health problems for fear of being pushed around or losing our job. More people will keep working until something goes very wrong, a total reversal of good health policy which emphasises early intervention. If you get really sick it means expensive intensive care which at £600 a night wipes out any possible gains to the UK economy of struggling on at work for a few months. A health system that cannot tolerate sickness is a zero sum game. If people are afraid of health services and the people that provide them the system will fail. Any functioning health system actually has to look at illness right in the eyes. And then it has to care about the real-life-complex-mixed-up-messed-up people that need it. How we treat dis-ability matters, otherwise the numbers just don't add up.