Impact of Welfare Reform on Mental Health
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Impact of Welfare Reform on Mental Health



The UK government's cuts to welfare - known as 'welfare reforms' - will increase levels of mental illness, increase costs, inefficiency, inequality and injustice.

The UK government's cuts to welfare - known as 'welfare reforms' - will increase levels of mental illness, increase costs, inefficiency, inequality and injustice.



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Impact of Welfare Reform on Mental Health Presentation Transcript

  • 1. Government’s Welfare ChangesWhat will be the impact on people with mental health problems? Dr Simon Duffy ■ The Centre for Welfare Reform ■ Inside Government Conference, London ■ 24th October 2012 ■
  • 2. You can call anything a ‘reform’but it doesn’t make it so.
  • 3. Key points1.Changes will increase injustice2.Mental health will further deteriorate3.All caused by “Politics As Usual”4.How do we change our thinking?
  • 4. What are the changes?
  • 5. • End of Disability Living Allowance• Cuts in Housing Benefit & Council Tax benefit• Reductions in Access to Work• Reduced eligibility for ESA• Increasingly intrusive testing by ATOS• Introduction of Universal Credit• Benefits reindexed to increase poverty• End of Independent Living Fund• Increased eligibility for social care• Increasing bureaucracy in social care• Reducing budget levels in social care• Return people to institutions and care homes• Increasing social care charges• Increased taxes, e.g. VAT, Council tax• and many, many other measures
  • 6. Some big growth and some big cuts[Source: HM Treasury, 2010 October Spending Review]
  • 7. Biggest growth is in central spending
  • 8. Big cuts to benefits and social care
  • 9. What will be impact?
  • 10. Mental health will deteriorate as1.Inequality increases2.Targeting causes stigma3.As real poverty increases4.As mental health services increase
  • 11. Income inequality correlated with mental illness
  • 12. Some of this may be caused by practical aspects ofpoverty, e.g. debt:45% of people in debt have mental health problemscompared to 14% of people who are not in debtDeveloping unmanageable debt is associated withan 8.4% risk of developing a mental health problemcompared to 6.3% for people without financialproblems (i.e. a third higher)Relative risks for people in debt: alcoholism (2x),drug addiction (4x), suicidal ideation (2x)Martin Knapp, 2012 Tizard Lecture
  • 13. Some of this may be caused by psychologicalaspects of poverty, e.g. stigma: Chick Collins on the ‘Scottish Effect’
  • 14. Current cuts will target and further stigmatiseparticular groups, e.g. disabled peopleBy 2015 benefits - will be cut by more than £18billion, local government in England will be cut by£11.3 billion. 50% of local government spending ison social care for disabled people.58% of all cuts target disabled people and people inpoverty36% of all cuts target disabled people24% of all cuts target those who need social care -1.9% of the population
  • 15. WomenCentre in Halifax at the front line
  • 16. Mental illness one of many inter-locking problems
  • 17. Of 44 women working with WomenCentre:Managing a serious health condition 64%Finding a safer place to live 27%Living with childhood abuse 51%Didn’t finish their education 76%Recent experience of domestic violence 85%Fractured family (for those with young families) 66%Children experienced abuse (for those with children) 55%Living with a severe level of mental illness 55%Living with some mental illness 91%History of drug or alcohol misuse 52%Victim of crime 41%Perpetrator of crimes 39%Worried by debt or lack of money 65%
  • 18. Service label N Urgent need N Real need NVictim of domestic 55 Debt 50 Better self-esteem 64violenceMentally Ill 39 Housing 48 To overcome past 54 traumaCriminal 35 Benefits 46 To manage current 51 traumaPoor Mother 33 Health 37 To stop being bullied 50Misuses Alcohol 24 Rent 32 Guidance 50Uses Drugs 22 Criminal Justice 24 Relationship skills 45 AdvocateViolent 19 Dentistry 8 Mothering skills 26Chronic Health 16 Others 3 Others 1Condition
  • 19. Our hypothesis - poor mental health is linkedto real poverty. The multiple reinforcing erosion of personal resilience
  • 20. These findings [better long-term outcomes for schizophrenia indeveloping countries] still generate some professional contentionand disbelief, as they challenge outdated assumptions thatgenerally people do not recover from schizophrenia and thatoutcomes for western treatments and rehabilitation must besuperior. However, these results have proven to be remarkablyrobust, on the basis of international replications and 15-25 yearfollow-up studies. Explanations for this phenomenon are still at thehypothesis level, but include:1. greater inclusion or retained social integration in the communityin developing countries, so that the person retains a role or statusin the society2. involvement in traditional healing rituals, reaffirming communityinclusion and solidarity3. availability of a valued work role that can be adapted to a lowerlevel of functioning4. availability of an extended kinship or communal network, so thatfamily tension and burden are diffused, and there is often lessnegatively expressed emotion in the familyDr Alan Rosen from Destigmatising day-to-day practices: What Can Developed Countrieslearn from Developing Countries? World Psychiatry 2006, 5: 21-24
  • 21. Rather than reducing inequalities itself, theinitiatives aimed at tackling health or socialproblems are nearly always attempts tobreak the links between socio-economicdisadvantage and the problems it produces.The unstated hope is that people -particularly the poor - can carry on in thesame circumstances, but will somehow nolonger succumb to mental illness, teenagepregnancy, educational failure or drugs.Wilkinson & Pickett, The Spirit Level
  • 22. Reformingmental health
  • 23. Q: Why is this happening?
  • 24. A: Politics As Usual (PAU)
  • 25. Possible explanations include:Existing patterns of prejudice and stigmaFragmentation of advocacy groupsDependency of charity sector on governmentComplexity of welfare systemIgnorance about our rightsPandering to key electoral groupsCorruption or lobbying by profit-making groups
  • 26. We don’t understand the truth
  • 27. Money is really recycled to the middle
  • 28. Current crisis framed by need toProtect the ‘middle’ - the swing voterDisguise the cause - i.e. house price inflationFind scapegoats - poor, disabled people etc.Protect popular items - e.g. NHS & PensionsSeek favour from sponsors (corporate bodies)
  • 29. What can we do?
  • 30. Four possible responses1.Challenge - don’t accept lies2.Connect - use each other better3.Campaign - argue for an alternative4.Create - develop real solutions
  • 31. Lure the tiger from the mountainNever directly attack a well-entrenchedopponent. Instead lure him away from hisstronghold and separate him from hissource of strengthFrom The Secret Art of War - 36 Strategies
  • 32. Connect and rebuildIt is easy to talk about cooperation, but inreality we are in our current mess becauseit is hard to connect, develop sharedinterests and overcome jealousies andconflicts.But, if we are not building, we aredestroying
  • 33. 1. Human Rights - Betterfundamental legislation2. Clear Entitlements - Its ‘mybudget’3. Avoid Crisis - Familysupport, lower thresholds4. Full Access - No ‘special’funding for services5. Choice & Control -Freedom, capacity6. Fair Incomes - Enough forcitizenship7. Fair Taxes - No ‘specialtaxes’, no charges8. Sustainability - Rethinkhealth/social care split
  • 34. The Centre for Welfare Reform• Welfare state is good - it is just designed wrong.• Move away from meritocratic thinking, instead value human diversity & equality• New thinking must promote justice, citizenship, family & community.• Innovate to build practical alternatives
  • 35. You can get much moreinformation on all these You can also jointopics FREE at #FairSocietywww.centreforwelfarereform.orgSubscribe and Follow These slides are © Simon Duffy 2012 ■ Publisher is The Centre for Welfare Reform ■ Slides can be distributed subject to conditions set out at