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

1. Government’s Welfare Changes
What 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 points
1.Changes will increase injustice
2.Mental health will further
deteriorate
3.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 as
1.Inequality increases
2.Targeting causes stigma
3.As real poverty increases
4.As mental health services increase

11. Income inequality correlated with mental illness

12. Some of this may be caused by practical aspects of
poverty, e.g. debt:
45% of people in debt have mental health problems
compared to 14% of people who are not in debt
Developing unmanageable debt is associated with
an 8.4% risk of developing a mental health problem
compared to 6.3% for people without financial
problems (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 psychological
aspects of poverty, e.g. stigma:
Chick Collins on the ‘Scottish Effect’

14. Current cuts will target and further stigmatise
particular groups, e.g. disabled people
By 2015 benefits - will be cut by more than £18
billion, local government in England will be cut by
£11.3 billion. 50% of local government spending is
on social care for disabled people.
58% of all cuts target disabled people and people in
poverty
36% of all cuts target disabled people
24% of all cuts target those who need social care -
1.9% of the population

16. WomenCentre in Halifax
at the front line

17. Mental illness one of many inter-locking problems

18. 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%

19. Service label N Urgent need N Real need N
Victim of domestic 55 Debt 50 Better self-esteem 64
violence
Mentally Ill 39 Housing 48 To overcome past 54
trauma
Criminal 35 Benefits 46 To manage current 51
trauma
Poor Mother 33 Health 37 To stop being bullied 50
Misuses Alcohol 24 Rent 32 Guidance 50
Uses Drugs 22 Criminal Justice 24 Relationship skills 45
Advocate
Violent 19 Dentistry 8 Mothering skills 26
Chronic Health 16 Others 3 Others 1
Condition

20. Our hypothesis - poor mental health is linked
to real poverty.
The multiple reinforcing erosion of personal
resilience

22. These findings [better long-term outcomes for schizophrenia in
developing countries] still generate some professional contention
and disbelief, as they challenge outdated assumptions that
generally people do not recover from schizophrenia and that
outcomes for western treatments and rehabilitation must be
superior. However, these results have proven to be remarkably
robust, on the basis of international replications and 15-25 year
follow-up studies. Explanations for this phenomenon are still at the
hypothesis level, but include:
1. greater inclusion or retained social integration in the community
in developing countries, so that the person retains a role or status
in the society
2. involvement in traditional healing rituals, reaffirming community
inclusion and solidarity
3. availability of a valued work role that can be adapted to a lower
level of functioning
4. availability of an extended kinship or communal network, so that
family tension and burden are diffused, and there is often less
negatively 'expressed emotion' in the family
Dr Alan Rosen from Destigmatising day-to-day practices: What Can Developed Countries
learn from Developing Countries? World Psychiatry 2006, 5: 21-24

23. Rather than reducing inequalities itself, the
initiatives aimed at tackling health or social
problems are nearly always attempts to
break the links between socio-economic
disadvantage and the problems it produces.
The unstated hope is that people -
particularly the poor - can carry on in the
same circumstances, but will somehow no
longer succumb to mental illness, teenage
pregnancy, educational failure or drugs.
Wilkinson & Pickett, The Spirit Level

24. Reforming
mental health

25. Q: Why is this happening?

26. A: Politics As Usual (PAU)

27. Possible explanations include:
Existing patterns of prejudice and stigma
Fragmentation of advocacy groups
Dependency of charity sector on government
Complexity of welfare system
Ignorance about our rights
Pandering to key electoral groups
Corruption or lobbying by profit-making groups

28. We don’t understand the truth

29. Money is really recycled to the middle

30. Current crisis framed by need to
Protect the ‘middle’ - the swing voter
Disguise the cause - i.e. house price inflation
Find scapegoats - poor, disabled people etc.
Protect popular items - e.g. NHS & Pensions
Seek favour from sponsors (corporate bodies)

31. What can we do?

32. Four possible responses
1.Challenge - don’t accept lies
2.Connect - use each other better
3.Campaign - argue for an
alternative
4.Create - develop real solutions

33. Lure the tiger from the mountain
Never directly attack a well-entrenched
opponent. Instead lure him away from his
stronghold and separate him from his
source of strength
From The Secret Art of War - 36 Strategies

34. Connect and rebuild
It is easy to talk about cooperation, but in
reality we are in our current mess because
it is hard to connect, develop shared
interests and overcome jealousies and
conflicts.
But, if we are not building, we are
destroying

35. 1. Human Rights - Better
fundamental legislation
2. Clear Entitlements - Its ‘my
budget’
3. Avoid Crisis - Family
support, lower thresholds
4. Full Access - No ‘special’
funding for services
5. Choice & Control -
Freedom, capacity
6. Fair Incomes - Enough for
citizenship
7. Fair Taxes - No ‘special
taxes’, no charges
8. Sustainability - Rethink
health/social care split

36. 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

37. You can get much more
information on all these
You can also join
topics FREE at www.campaignforafairsociety.org
#FairSociety
www.centreforwelfarereform.org
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These slides are © Simon Duffy
2012 ￭ Publisher is The Centre
for Welfare Reform ￭ Slides can
be distributed subject to
conditions set out at
www.centreforwelfarereform.org