Anguish and austerity: the personal cost of cuts

There are so many individual experiences that might give rise to political awareness or finally nudge someone into political activity- for many of my generation it might have been involvement in the anti-war movement prior to the Iraq war, or for junior doctors the unprecedented attacks on the NHS and our working conditions. 

For me however, it was working in community mental health services in a deprived section of north London at the moment that austerity began to bite.

The last two Conservative lead governments have presided over a programme of austerity more extreme and more punitive than any that has gone before it. The impact on our communities and public services has become increasingly difficult to conceal (particularly with the mobilisations and strikes by doctors, teachers and post office workers in the past year which have highlighted the damage wrought by cuts and privatisation), however the very real plight of individuals on the sharp end of austerity has been less well documented. Hidden behind the dominant yet completely bogus rhetoric around the urgency of deficit reduction and “belt tightening” lie tragic human consequences and nowhere has this been more serious than for those with disabilities and chronic mental illness who have seen the removal of the Independent Living Fund and Disability Living Allowance.

Many of us working in mental health have borne witness to the psychological impact of benefits sanctions. We have worked with patients experiencing relapse of their chronic illnesses after the humiliation and anxiety of being put through the Work Capability Assessment (WCA) and know the frustration and powerlessness when our own recommendations are ignored and vulnerable patients are forced into work prematurely. There are a handful that I recall vividly: a  Kurdish woman with PTSD who had a traumatic reliving of her previous experience of torture during the assessment and yet somehow was still fitted for work, a middle-aged woman who had not been able to work for several years due to agoraphobia and panic disorder suddenly finding herself forced into searching for jobs on the threat of being sanctioned. There were patients sanctioned for failing to attend the job centre whilst being detained on a section in hospital and then the harrowing A&E admissions of patients with fully formed suicidal plans triggered by the anxiety of not knowing whether they'll be able to sustain themselves if their support is discontinued or they are required to pay the additional bedroom tax.  

Based purely on day to day clinical experience we knew the fitness to work tests were triggering significant mental health problems and the concrete evidence to support this is steadily mounting. The first example of the WCA process being blamed directly for a completed suicide came in a coroner’s report in 2015 after Michael O’Sullivan, a 60-year-old man had his Employment Support Allowance discontinued despite providing reports from three doctors stating that he had long-term depression and agoraphobia and was therefore unable to work- he killed himself at his home on 24 September 2013.

His suicide is amongst hundreds that have now been ruled as linked to the WCA. A study carried out by psychiatrists at the mental health trust where I am based in London found that between 2010-2013 across England as a whole, the WCA was associated with: 590 suicides, 725,000 additional prescriptions for antidepressants and 279,000 additional cases of self-reported psychiatric problems.

For any civilised society such consequences would outweigh any potential benefit to the public purse but the fact that such welfare reforms have ostensibly been enacted to ‘‘balance the books’’ whilst hand-outs are given to the top earners in the form of tax breaks makes it clear that this has all been a very deliberate ideological choice and not one borne out of necessity.

Under Ian Duncan-Smith’s stewardship of the DWP, the UK became the first country to come under investigation by the United Nations for systematically violating the human rights of disabled people - this is a shameful legacy, and although they have attempted to avert blame by fostering a culture that vilifies and dehumanises disabled people, it shames us all if we collude with it and fail to hold our government to account for these on-going abuses.  This means offering as much solidarity and practical support to groups such as Disabled People Against Cuts and the Mental Health Resistance Network who despite the odds have achieved extraordinary things in highlighting this government’s failings. Along with that sense of powerlessness that I began to feel during my first year of community psychiatry, DPAC and my involvement in their peaceful direct actions offered some hope, likewise joining the huge mobilisations against austerity by groups such as the People’s Assembly. It is also crucial to continue to mobilise in support of the current progressive Labour leadership which is providing robust meaningful alternatives to austerity.

Whilst I was sitting in outpatient clinics listening to patients’ accounts of the fitness to work assessments and their experience of being sanctioned, and writing supporting letters on their behalf to Atos assessors that I knew would be disregarded, I wished for a way to convey the full extent of these injustices.  ‘I, Daniel Blake’ the film by Ken Loach released this week is exactly the piece of work that I hoped would one day be made to tell these stories and reveal the very dark side of austerity and I would urge everyone to see it.  

Dr Mona Kamal

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