Links between benefits and mental ill-health could be recorded by doctors in new plan

[Image: Getty/iStock].

The link between disability benefit assessments, mental health problems and increases in suicide rates could be made explicit in a new plan announced in medical journal The Lancet.

Kate Allsopp and Peter Kinderman have called for mental health professionals to record psychosocial codes in official NHS records, to show whether a patient is suffering from the effects of social inequality, poverty or trauma.

Links between the Work Capability Assessment (WCA) and an increase in suicides, mental health problems, and prescription of antidepressants are specifically mentioned, following on from a study covered by This Site here.

The proposal in The Lancet states [boldings mine]:

It is well known that poverty and social inequity are major determinants of our mental health, and the United Nations Special Rapporteur characterises mental health care not as a crisis of individual conditions, but as a crisis of social obstacles, which hinders individual rights.

It is important, therefore, that the circumstances that have given rise to distress should be formally recorded alongside the distress itself. Psychosocial codes… incorporate descriptive information regarding adverse life experiences and living environments, but are almost never used or reported in clinical practice or academic publications.

These quasi-diagnostic codes document neglect, abandonment, and other maltreatment… homelessness, poverty, discrimination, and negative life events in childhood, including trauma… problems related to family upbringing, and housing and economic problems.

Broadening routine data capture within UK National Health Service records could establish more inclusive, social, systemic, and psychologically comprehensive patterns of difficulties, which could target information regarding established social determinants of mental health problems, such as inequality, poverty, and trauma.

Imagine if it were as serious to fail to document extreme poverty as it would be for a clinician to fail to identify severe depression.

We do not expect that clinicians should resolve such difficulties; it is not the job of mental health professionals to end poverty.

Nevertheless, proper recording of psychosocial… codes in the context of psychiatric diagnoses is imperative because of the close relationship between the two.

The UK government programme of reassessing disability benefits… using the Work Capability Assessment has been associated with an increase in suicides, mental health problems, and prescription of antidepressants.

Transitions into poverty (relevant to codes [on] inadequate housing… lack of adequate food… extreme poverty; and… low income) have been associated with increased odds of children developing socioemotional behavioural difficulties, and individuals who have had an institutional upbringing… are approximately 11 times more likely to experience paranoia compared with those with a less disrupted early history.

As clinicians, we might be better able to serve our clients if we can use such data capture to apply more effective pressure on the political system and drive wider system reform.

Source: A proposal to introduce formal recording of psychosocial adversities associated with mental health using ICD-10 codes – The Lancet Psychiatry

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  1. Liz Douglas September 3, 2017 at 9:27 am - Reply

    A government jobs website is advertising for cognitive behavioral therapists to carry out its ‘return-to-work’ programme. In short, Osborne is going to pay therapists to ‘coerce’ mentally ill people back into the workforce.

    The £35,000 a year job, based in Surrey, Sussex and Kent, was plugged on an NHS jobs website on behalf of major British outsourcing firm G4S. It comes after chancellor George Osborne tabled proposals to provide jobseekers with psychological therapy to help them back work in his April 2015 budget.

    He said the government aims to give online therapy to 40,000 recipients of Jobseeker’s Allowance and Employment and Support Allowance from early this year, as well as putting therapists in more than 350 job centres.

    In an open letter to The Guardian last year, the regime – dubbed ‘get to work therapy’ – was condemned as ‘utterly unacceptable’ by more than 400 psychologists, counsellors and academics.

    They raised fears over Osborne’s plans to link welfare with therapy, claiming that under the coalition government’s benefits rules claimants were being subjected a “new, intimidatory kind of disciplinary regime”.

    In the letter the authors blast: “Get to work therapy” is manifestly not therapy at all.

    It is time for the field’s key professional organisations to wake up to these malign developments, and unequivocally denounce such so-called “therapy” as damaging and professionally unethical.
    But despite fierce opposition from hundreds of psychology professionals to the back-to-work therapy programme, the government has pushed ahead with the policy regardless.

    As part of the G4S role therapists are required to provide “return-to-work advice” with a focus on “practical techniques” to help mentally ill job seekers “enter and sustain employment”.

    Figures show between 2011 and 2012 suicide rates rose across the UK as austerity began to bite, with men between the ages of 45 and 59 especially at risk.

    David Harper, a member of the Psychologists Against Austerity group and one of the 442 signatories asserted social inequality is a huge contributor to mental health problems. He said:

    What we’re concerned about is the need for development of policies which aim to reduce inequality.

    The cuts being made to benefits are affecting the poorest in society and the more stringent policies mean people are being made to jump through endless hoops when they are at their most distressed.
    Although there’s no hard evidence to link the rise in mental health issues to the government’s tough welfare regime, reports show a strong correlation.

    In a damning report from the Journal of Epidemiology and Community Health, 590 suicides and a marked increase in antidepressant prescriptions were linked with work capability assessments (WCA).

    The research, along with countless more anecdotal evidence, shows that, more likely than not, fit-for-work tests are taking serious toll on mental health.

    • Mike Sivier September 3, 2017 at 12:22 pm - Reply

      That’s from a while ago.

  2. Claire September 3, 2017 at 12:05 pm - Reply

    I’m glad you’ve come to realise that the biopsychosocial model is extremely important for human beings Mike. Now you need to go back an address a previous post from last year where you quoted some neo-liberal right wing undergrad who had written a paper cherry picking quotes from another paper to discredit it. Hold yourself to the standards that you expect from other journalists and admit your mistake. Human beings cannot have mental health without physical health and vice versa. Nor can we have either without the removal of oppression, discrimination, and the personal, cultural, structural barriers that are placed in our way (PCS model).

    Well done for highlighting this though.

    • Mike Sivier September 3, 2017 at 12:19 pm - Reply

      No, the biopsychosocial model – as practised by Tories and their lapdogs in the private companies that run health assessments for disability and sickness benefits – is nonsense.

      • Claire September 3, 2017 at 1:17 pm - Reply

        That is something we can both agree on. I don’t remember you mentioning “as practiced by the Tories” in that previous blog though. My apologies if I misinterpreted it.

  3. hugosmum70 September 3, 2017 at 6:31 pm - Reply

    the mere fact that under the tories, costs are going up and up, gas,electric. etc… is enough now to make some get very depressed,without the help from other aspects like assessments etc……. food costs around 4 times as much now to just over a year ago.(at least mine does) meaning we get less for our money. ongoing from that, it means we can get out less. we cannot keep up with any friends we may have till we stop seeing them other than a phone call or skype message. or fb one. or just a card at xmas .possibly birthdays.thats not enough. people need face to face interaction particularly as we get older ,to ward off boredom, depression, senility,and alzheimers….. they used to say (and some still do) that doing puzzles etc when you live alone helps to ward off such things. ive tried it and can think of nothing more boring . people need people not puzzles. thats just some person saying that just to stop him/herself feeling guilty at not having more input in a parents life. think i should write a book on getting old. though i doubt anyone who isnt in the middle of coping with it under these situations we have now, will bother to read anything like that/

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