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Ken MacIntosh: IDS was right to try to get the sick and disabled into work


It’s clear that Iain Duncan Smith is now preparing a new attack on disabled people“. So said Labour’s Andy Burnham last year in response to proposals by IDS, then Secretary of State for Work and Pensions, that decisions arrived at by the Work Capability Assessment (WCA) be more personalised. IDS wanted to move away from the clumsy ‘fit/unfit-to-work’ binary when deciding who qualified for what used to be called Incapacity Benefit (and in so doing, soften a policy introduced by Labour as part of the 2007 Welfare Reform Act).

What Burnham was saying, in exactly so many words, was that IDS wanted to attack handicapped people: that, in moments of quiet reflection, possibly while sipping on his favourite malt whisky or watching an episode of Sex Box, IDS would brood upon how he might launch assaults upon people with spina bifida. Burnham was implying psychopathy in IDS. Such ululating left-wing hysteria was the standard response to IDS. The [now defunct] Atos Victims Group website merged together photographs of IDS and Josef Mengele, ranting that the two were morally comparable. In the realms of socialist madness, IDS’s flawless cue-ball of a head was (and is) but a veil obscuring a screaming abattoir of the mind.

The implementation of the WCA provoked much of this rage. It was viewed by many as being particularly harsh on those with mental-illnesses. The Royal College of Psychiatrists attacked the changes. When IDS went a step further and stated, with reference to certain psychiatric disorders, that said changes would be therapeutically beneficial, charities reacted with fury.

But IDS was right. Many of ‘the mentally ill’ would benefit from being impelled to work. For a small sample of papers on the positive effects of employment on higher functioning schizophrenics see here, here, here, here, here, here, here and here. The last of these papers states that, “vocational reintegration is not only an outcome but a crucial element in the recovery process”. Work is not something that all schizophrenics should be sheltered from until deemed well – ideally, it should be part of the cure.

But this has not been the case. I recall visiting a publicly-funded employment-training project in Glasgow several years ago. The project consisted of an impressive mock-up office where those on benefits and with long-standing diagnoses of mental illness could learn various office skills. While being shown around by one of the staff, an avuncular, jolly man, I asked him how many of his students went on to secure jobs. He sighed and told me that they all had social workers who “knew how to fill in forms” and who saw it as their duty to maximise their ‘clients’’ welfare payments. I had asked the trainer how this equated into students progressing onto work, in terms of numbers. “Nobody progresses into employment”, he had told me. “They get enough on benefits”.

For the negative effects of ‘benefits imposed isolation’, consider the relatively poor recovery rates for schizophrenia in rich, developed countries, where the chances of a ‘good’ outcome are as much as 75 per cent lower than in developing nations. Anthropologist Neely Myers has studied the reasons for this disparity, examining the lifestyles of schizophrenics in India. Though she identifies many issues, they can in large part be reduced to her statement that better outcomes in India are due to “less segregation of the mentally ill, and hence, less stigma”.

But what does ‘recovery’ actually mean in schizophrenia? One problem with studies that compare treatment efficacy around the world lies in the attempt to synchronise definitions of recovery. The American Psychiatric Association includes phrases such as “impaired role function” and “vocational dysfunction” as part of its diagnostic criteria. As such, an individual may still be delusional, but because they are seen to function (by having a job), they no longer meet the diagnostic criterion of impaired vocational role function, and have therefore, ‘recovered’. In this sense, the welfare state, by inhibiting people from working, is literally making them mad.

But whatever the criteria for recovery, let’s consider hard financial reality. The fact is, some schizophrenics could well be working anyway, irrespective of any therapeutic benefits or lack thereof. Research from 2009 found that 72.9 per cent of a cohort of schizophrenics in Mumbai lived independently, despite a recovery rate of just 30.5 per cent, leaving over 40 per cent ‘functioning-but-not-recovered’ (a 2007 study showed that only 12.9 per cent of schizophrenics in the UK had paid work, the figure falling to 6.7 per cent in London). The authors of the Indian study suggest that “schizophrenia may be a predominantly biological illness with a uniform recovery rate across cultures and regions”. Thus, the disparity between first and third-world recovery rates exists primarily within having a job.

Nobody is arguing that work is suitable for all or even most schizophrenics. Often issues such as cognitive impairment, comorbidities or poor physical health make this impractical. And the nature of work itself in modern society can create its own problems.

As Neely Myers points out, entry-level jobs in The West are often “stressful settings like McDonald’s”, unlike in India, where less demanding roles are plentiful. Schizophrenics themselves report their fear of the ‘McDonald’s-nightmare-scenario’. And herein lies a challenge. Do the jobs exist that would allow higher-functioning schizophrenics to make the leap into employment? The raising of the minimum wage to £9/hour by 2020 (which IDS applauded) will make employers ever more reluctant to take on such employees. Lord Freud, who suggested that Government could make up the wages of disabled people who were, efficiency wise, “not worth” the minimum wage, was met with outrage and forced to apologise to the Prime Minister for his “foolish and offensive” comments. None of this is of help to schizophrenics who would work.

It is easy, politically, just to throw money at problems. To follow the less obvious but efficacious path takes guts, as does facing down labels like “evil” and “scum”, which some on the Left are so wont to throw about. Despite his support for the hike in the minimum-wage, I believe that IDS was essentially right, however let down he (and claimants) may have been by implementation. He is not a psychopathic cue-ball.

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Ken MacIntosh
Ken MacIntosh
Ken MacIntosh is an NHS psychiatric nurse and is married with one daughter. Ken is interested in politics and mental health issues.

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