Every so often when ministers are considering a policy, they send a little kite up to see how it's received. Sometimes it gets hit by a lightning bolt of fury from a party's target voters, and is never heard of again. Sometimes it flutters about and no-one plays a blind bit of notice. And sometimes the kite gets rapturous applause. There seems to be a mixed response to the kite flown today that people with anxiety and depression could be forced to have a talking therapy such as cognitive behavioural therapy or risk losing their benefits.
On the one hand, it's welcome that ministers want to help people with mental health conditions that can be managed so that someone can go back to work. Unemployment is hardly conducive to good self-esteem and strong mental health. On the other, it's pretty darn difficult to force someone to take any treatment at all, not to mention unethical. Health Select Committee chair Sarah Wollaston doesn't like it for that reason:
.@IsabelHardman Fundamentally flawed as incompatible with principle of consent to treatment & impossible to implement. Needs correcting
— Sarah Wollaston MP (@drwollastonmp) July 13, 2014
But there's another point that's worth considering, which is that talking therapies often have very long waiting lists. This policy would perhaps make more sense were talking therapies so readily available that anyone could ask for them and find themselves in a consulting room or talking to a therapist over the phone within days. But that is not the case, and is not anywhere near the case, either. Mind, the mental health charity, estimates that one in 10 patients waits longer than a year to receive psychological treatment. There is no suggestion in today's kite that incorporating talking therapies as mandatory element of the work programme would include investment in increasing the availability of those treatments.
If ministers don't want quite so many people floating about on benefits who could, given the right support, return to work, or if they don't want people who leave work because they have not been given the right support and their condition has deteriorated, might I humbly suggest that the thing to do is not to mandate access to that help, but ensure it is on offer in the first place? What is the point of pushing someone through a therapy that must have their consent and engagement to have even a cat's chance of working when another person who is not claiming employment and support allowance but is desperate for treatment must wait? And why must policy be skewed so that it is only those whose illnesses mean they have left the workplace already who are prioritised for treatment?
This is one of the sillier remarks from a government source:
“'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.'
It is indeed bizarre that people on ESA are undergoing no treatment whatsoever, just as it is bizarre that people suffering from illnesses which can kill must wait over a year for treatment.
Recently health minister Norman Lamb - who has told the Telegraph that he opposes this benefits policy - admitted to Radio 4 that he couldn't say when the government would be able to achieve parity of esteem between the way physical and mental health are treated by the NHS, even though this is a goal the government has set itself. Charles Walker, former chair of the all-party parliamentary group on mental health and an outspoken Conservative campaigner on this issue, recently wrote on Coffee House that the government's rhetoric fails to match the reality.
Perhaps ministers could reel their kite in a little and have a good think about the reason so many people are languishing on benefits with mental health problems. It might not be because they've never been forced to take up a therapy. Instead, it might be because that therapy has never been available to them in the first place.