Forced therapy or be punished?! Ethical?!

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cral
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Forced therapy or be punished?! Ethical?!

Post by cral » Sun Jul 13, 2014 9:48 am

I've just read this article http://www.telegraph.co.uk/news/politic ... ssion.html which essentially says the government want to be able to force people with common mh problems receive therapy or have their benefits sanctioned! I don't think such nonsense would be able to get passed but is this really the direction we're heading in as a profession if so I don't really see it to be any different to the take your medication or we'll inject you/put you into hospital approach. I really hope professional bodies speak up about this as even the thought of it is obsurd so for many different reasons!

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miriam
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Re: Forced therapy or be punished?! Ethical?!

Post by miriam » Sun Jul 13, 2014 7:29 pm

Can you imagine the physical health equivalents that could follow?

Obese? Have heart disease? Exercise and follow this diet plan or your benefits will be stopped.
Diabetic? Follow the diet and lifestyle advice to keep your HbA1c below 7 or your benefits will be stopped.
Smoke? Give up smoking or your benefits will be stopped.

At one level I can see the rationale, but its a bit of a perverse incentive to punish people for mental health problems. And as with physical health, it seems unfair to give different consequences for people who had no control over the factors that predisposed them to mental health problems (that the government failed to address further up the food chain) and there isn't really the availability of therapy that will prevent and treat the more chronic conditions (due to government cuts). Just seems yet another way to blame claimants :(
Miriam

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cral
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Re: Forced therapy or be punished?! Ethical?!

Post by cral » Sun Jul 13, 2014 8:00 pm

I like the analogy with physical health-I hadn't considered it like this and it's a valid point!

It's very much jumping on the bandwagon that cbt Is the solution to all of our problems. Personally I would feel rather uncomfortable delivering such a therapy as the therapy would merely be a political statement. The very notion undermines what therapy is all about-trying to reduce the power imbalance, empowering clients-we can say goodbye to that! Instead we might as well set up a depressed bootcamp!

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Gilly
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Re: Forced therapy or be punished?! Ethical?!

Post by Gilly » Mon Jul 14, 2014 9:07 am

its something that has definitely sparked a debate on social media!

The other thing to consider is even if we take at face value, that CBT might be a useful approach to use for these people (and considering that most of the people who are in the benefits system will have absolutely MASSIVE systemic and environmental issues maintaining their difficulties, its effectiveness might be very short limited) how well will this approach work under duress?
You're not calling for help, are you?! ;)

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Re: Forced therapy or be punished?! Ethical?!

Post by Randomswirls » Mon Jul 14, 2014 10:12 pm

I don't know what to think about this as I highly doubt it will be implemented correctly. As someone who has been on ESA fairly recently for mental health and has also run numerous courses on ESA for people with mental health I feel I'm fairly well informed about it in my area of the country anyway!!!

Over the last few years I've really noticed a difference in how mental health is being treated within benefits. As a example it seems to be fairly common for people with mental health to not be called for medicals as you can't assess someone's mental health in a short appointment which you can do with physical health. The above is also true for PIP so I think there are really positive things happening there.

Currently ESA is very focused on the work side of things and if you are in the work related activity group you have to go for work focused interviews. When I attended mine it was a pure waste of time as I wasn't able to work at that point and my care team agreed. As a result i had a very nice chat with the lady about all sorts of general chit chat! Whilst I had a great care team if I didn't I would have welcomed some help but what I don't know is what help would have been useful that wouldn't normally be provided by a mental health team. That said am i correct in thinking that IAPT was set up with the belief that it would help people go back to work? If so surely that's what this is except in a more overt manner and if so I would hope that those excluded from IAPT (I'm not an expert but gather they don't typically deal with those on the more severe and enduring side of the spectrum) would be entitled to access it and that could be helpful for me!

One thing that I have also heard is that people want input from people going back to work and the 'CMHT' that I work in has a vocational service that is overrun and people who aren't entitled to there service want something similar. I have also had on several occasions ask if access to work would pay for a counsellor and I haven't really had a firm answer to this but it seems it would be more along the lines of a vocational counsellor which isn't what's being asked for.

I do agree with the points raised about physical health and am under no illusion that anything produced would be hugely useful per we but if done right I can see it being a good thing!

Edit to include a link here http://www.iapt.nhs.uk/silo/files/iapt- ... report.pdf page 5 talk about some of the KPI's being around economic gains including 45,000 people moving off benefits into work. Which seems along the same line of this.

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Re: Forced therapy or be punished?! Ethical?!

Post by Loula » Tue Jul 15, 2014 9:10 am

I think this is one of those things where a general and pretty sound principle has ended up being boxed up as something completely different. So, it's clear that job-seekers are a group who may have high levels of unmet/ unidentified MH needs who don't have great contact with GPs, and one way to access this group is through jobcentres. But there seems to be a trend in jobcentres/ with benefits to make things compulsory, and somehow the suggestion has come about that these people should be 'forced' to have therapy just as they should attend jobcentre appointments etc.

The whole issue of forced therapy is one that is quite widely discussed in forensic services. People often have therapeutic work as requirement from the Ministry of Justice, and can end up stuck if they don't engage. Some of those people will return to prison, but others who are too unwell to return can end up spending a lot of time in hospital. Obviously it's more complicated, as there is an issue of public protection and people are subject to the MHA, but it is an interesting issue to reflect on.

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miriam
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Re: Forced therapy or be punished?! Ethical?!

Post by miriam » Tue Jul 15, 2014 3:12 pm

Lets also be clear that at this stage there is no promise of extra funding for services to meet this need. There is no promise to upskill the staff within IAPT or add to the resources for adult mental health teams to meet the need of people with more chronic or severe problems. There is just a threat to take benefits away from people when they are at their most vulnerable, as though the lack of incentive is the issue, rather than the lack of appropriate support or the barriers to accessing it. Given that many adult mental health teams have sky high referral criteria and waiting lists of over a year for psychological therapy, this resource will need to have a significant increase to meet demand, and there will need to be highly skilled assessments of what is needed and how to engage people.

Sadly, like the idea of fining hospitals if they don't charge people from the outside of the EU for treatment, this seems to me like a way of saving money at the cost of the vulnerable. I'd encourage any genuine attempt to improve the mental health of the nation, including any projects that reduce barriers to accessing services, but this doesn't sound like they've thought it through at any level beyond reducing costs.

And let's not forget that this is a government who tax poor people for having a spare room, whilst leaving mansions unoccupied by super-rich foreign investors. They've cut legal aid and slashed spending on health and social care. They chase every penny of tax from ordinary individuals whilst letting massive international corporations pay next to none. They chase fraudulent benefit claimants whilst giving away a billion pounds by selling off the post office much to cheaply. They persecute small businesses for not paying minimum wage, whilst letting giant corporations give zero hours contracts and not pay domiciliary carers for travel time during their working day. Make no mistake about it - this is a cabinet of millionaires using the world financial situation caused by the banks ("austerity") as an excuse to give money to their rich chums at the cost of the poor and vulnerable people and the loss of the safety net of public services. The sooner they are gone the better.
Miriam

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