Lethal proposal for people with depression unable to work
People in the UK unable to work because of depression may have their benefits stopped if they do not undergo cognitive behavioural therapy, which it is assumed will cure them, a newspaper has reported. If this plan goes ahead, sizeable numbers of mentally ill people are likely to die.
“Hundreds of thousands of benefit claimants face being stripped of their state allowances if they refuse to undergo treatment for anxiety and depression, under radical plans being drawn up by ministers,” the Daily Telegraph reported.
“We know that depression and anxiety are treatable conditions. Cognitive behavioural therapies work and they get people stable again but you can’t mandate people to take that treatment,” a “senior government source” was quoted as saying.
“But there are loads of people who claim ESA who undergo no treatment whatsoever. It is bizarre. This is a real problem because we want people to get better.” The source “suggested that successful treatments could reduce the numbers of people with mental health issues claiming the benefits by up to 90 per cent.”
This displays an alarming lack of knowledge about mental health or, alternatively, a callous willingness to target the most vulnerable, knowing that their illness – along with widespread prejudice and ignorance – will make it harder for them to resist.
To begin with, it is by no means certain that there are large numbers of people whose depression is so severe that they are unable to hold down a job who have not tried one form of treatment or another. Those for whom it worked will, in many instances, be back in the workplace already.
Secondly, the very nature of depression means that some people will find it difficult or impossible to take up treatment, either because their general sense of hopelessness means that they do not think it will work or because they cannot get to sessions (some may not even be able to get dressed let alone attend an appointment).
Thirdly, though cognitive behavioural therapy (CBT) is helpful to many people and should be widely available, it is not clear that it is superior to other forms of psychotherapy, and no form of treatment is effective for everyone. As pointed out in a 2010 meta-analysis in Psychological Medicine by Pim Cuijpers and other researchers, “The effects of psychotherapy for adult depression are overestimated”.
Even where CBT or another treatment is effective, this does not mean that the patient will recover to the point that they can work. A 2014 article in the same journal: The effect of psychotherapy for depression on improvements in social functioning: a meta-analysis, by F Renner and colleagues, found that “Psychotherapy for depression results in small to moderate improvements in social functioning.”
It may be very significant for individual patients that they no longer neglect themselves as much, can care for their children with support, or only occasionally feel suicidal. However this does not mean that they can hold down a job.
Care minister Norman Lamb, to his credit, said that this was "not a sensible idea" and that "The idea that you frogmarch someone into therapy with the threat of a loss of benefits simply won't work." However he is a Liberal Democrat in a Conservative-dominated ruling coalition and it is not certain how much weight his objections will have – though at least one influential Tory shares his reservations.
Dr Sarah Wollaston is a former GP and chair of parliament’s health select committee. She condemned the proposal as “Unethical, unworkable nonsense”.
If the scheme is pushed through, many people with clinical depression who fail to turn up to CBT sessions will be left without enough money for food or heating, which may also increase suicidal tendencies. There is also a risk that some will be declared 'cured' after a short course of treatment even if they are still too depressed to work.
This is especially cruel because being clinically depressed, even without added problems, can be a very unpleasant experience. And people who have suffered in other ways may be especially at risk, for instance those who have had a major bereavement or who have been sexually abused.
If the government presses ahead with this plan, it will be a violation of universal human rights, in particular the right to security in the event of sickness or disability. It will also go against a more ancient rule which many people – whether Jewish, Christian, of other faiths or none – hold sacred: “You shall not kill.” An action which is practically certain to have a lethal effect on sizeable numbers of people should surely be considered in this light.
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