We can’t ‘pay people out of anxiety’ and need a new approach
Today it is reported that there are about 60,000 people in Scotland receiving Adult Disability Payments because of anxiety, and politicians do not seem to know how to respond to this. Given that this means more than one in eight people receiving disability payments are suffering from anxiety means we need to start getting our response in better shape.
This issue reflects an increasing problem we have with mental health and how we make policy. On the one hand, the Tories have attacked these payments from its traditional anti-benefits stance, demanding the Scottish Government cut taxes and stop spending the proceeds on benefits. This is an unsophisticated stance – to say the least.
The Scottish Government on the other hand says that disability payments are a human right. This statement in itself is also unhelpful – there isn't a defined level at which benefits need to be set to reach human rights, nor is there some human rights-based specification about what exactly is eligible for benefits payments. These are policy choices.
So both sides in this debate have simply reverted back to their preferred political slogans and there seems little evidence that either is engaging with the issue with any seriousness. This highlights the fundamental problem we are having with mental health issues.
Most people will see disability benefits as having two main functions. The first is to identify people who have permanent, irreversible physical or mental condition that must be managed constantly and who therefore need support to live with those conditions. The other is for people who are temporarily incapacitated in some way and need support during recovery.
The problem with mental health conditions is that while some fall into the former category (such as schizophrenia) the rest do not necessarily fall into the latter. Anxiety is not a condition which necessarily 'heals itself' given time. Rest and getting away from work pressures may help but being stuck at home with nothing to do but worry about your problems can actually make it worse.
If someone has a broken bone we do not sign them off work unless we know what broke the bone in the first place and we would not do it if the person concerned was to return immediately to exactly the same activity that broke the bone in the first place – yet this is what we do with mental health.
We diagnose the symptoms of mental health and if they are present we take action. Unfortunately the easiest action to take is to prescribed medication that dulls the symptoms. To return to the broken bone analogy, this is like someone turns up with a broken leg but the doctor doesn't inquire how it happened and doesn't set the bone but just prescribes painkillers and hopes the bone will get better.
Anxiety is almost always an environmentally-driven condition – there is something in the world around us which is acting as a stressor and it is causing our mind to react in a way which becomes counterproductive. Unless the initial cause is addressed, it is unlikely that the symptoms can be properly managed or even reversed.
This is the heart of the problem; most mental health conditions are not medical problems but social ones. They are not best addressed medically but socially. In other words, they are not medical issues, they are care issues. That is why Common Weal was pushing for mental health support to be part of the mandate of the National Care Services rather than the NHS (before that legislation fell apart).
In fact more than just care, anxiety is a 'Public Care' issue. Rates of anxiety across society have risen sharply in the internet era – presenting about 20-per cent more now than at the dawn of the internet. When one person suffers a condition it is individual; when there is a 20 per cent increase in little over two decades it is a social problem.
That is where Public Care comes in; we all recognise that part of a health services is to advise us on how to live our lives in ways that maximise our health (don't smoke, eat healthily, avoid asbestos, take exercise). We heavily regulate for public health, banning substances which pose a health risk.
It is time we did the same for care issues, and especially mental health issues. If we know that a social phenomenon is causing significant drops in public wellbeing we must investigate it, provide public guidance about it and regulate it appropriately. Avoiding stressful and anxiety-inducing phenomena in society is no more 'our own problem' than avoiding asbestos is.
When one in eight people on disability payments are suffering from anxiety and when signing them off or providing payments is unlikely to actually improve the condition, it is an ineffective public policy response. That it is cheaper than a proper system of regulating harmful activity and providing proper, effective care for people who suffer is no argument in favour of the current approach.
We still need a proper National Care Service and we need a much stronger approach to 'Public Care' – or this problem risks getting worse. Common Weal describes a comprehensive system for both in Caring for All (print copy available here).