Right To Warn

John Pring writes:

New government research has proved disabled activists were right to warn that receiving employment advice on top of NHS talking therapy would push many people with mental distress further away from the jobs market.

Mental health system survivors, anti-cuts activists and allies have been campaigning for more than a decade to warn that linking NHS treatment with employment advice could have serious consequences for many people with mental distress.

And now a study by the Office for National Statistics (ONS) shows they were right.

The government-funded study examined the impact of providing voluntary sessions with employment advisers alongside NHS talking therapy, checking the progress of those taking part three years after they first received support.

The study shows that, for those already in work or off sick from a job, adding employment advice to talking therapy reduced average earnings and the probability of being in work, compared with those only receiving talking therapy.

It also showed that, for most groups who were not working, providing voluntary employment advice sessions on top of talking therapy led – on average – to increased earnings and a higher probability of being in work.

But crucially, for those who were out of work and had the highest barriers to employment – those described as “long term sick or disabled” – the addition of employment advice to regular talking therapy made it less likely that a disabled person would be in work and reduced average monthly earnings, compared with those only receiving NHS talking therapy.

For this final group of disabled people, three years on from starting the employment advice sessions, the probability of being in paid employment fell by four percentage points (3.6), while average earnings fell by nearly £150 a month (£148.30), compared with those who were just receiving talking therapy.

Dr Jay Watts, a disabled activist and consultant clinical psychologist, said: “For a decade, disabled people’s organisations and survivor-led groups warned about exactly this: that bolting employment support onto therapy doesn’t add help — it changes what therapy is.

“The therapy room is meant to be the one place a person isn’t appraised for their economic usefulness, and the moment the work-and-welfare system is let into that space, the therapy itself is contaminated.

“We were marching on jobcentres over this while the professional bodies equivocated, and now it is borne out in the government’s own data.”

She said the data showed the impact on people who were long-term sick and disabled was “the exact opposite of what was promised”.

Watts called on the Department for Work and Pensions (DWP) to finally listen to disabled-led groups about the scheme’s impact on mental health.

She said: “Being handed ‘support’ and then watching one’s life deteriorate does not land neutrally; in the clinic it deepens shame and hardens the conviction of personal failure, and under a welfare system that equates worklessness with worthlessness, that is precisely the pressure that corrodes mental health rather than restoring it.

“None of this means employment support helps no-one – for people who were out of work [and not long-term sick or disabled] and actively seeking it, it did raise earnings and employment, and that matters.

“But an intervention that rewards those who choose it and harms those who are unwell is the very last thing you make compulsory.

“These were people who volunteered, who wanted the help and were harmed anyway.

“If something people actively chose can still worsen outcomes for sick and disabled people, then forcing similar interventions on almost everyone out of work, as [government adviser] Alan Milburn appears set to recommend, is ideology in the teeth of the evidence.”

Paula Peters, a member of the national steering group of Disabled People Against Cuts, said that adding employment advisers to a mental health service “only pushes people in mental distress further from the workplace”.

She said: “Campaigners have said for years that people in serious mental distress and trauma need investment in mental health services, crisis management and time to deal with their trauma without the additional trauma of dealing with an employment adviser giving advice on top of talking therapies.”

She said that successive governments “keep getting it wrong” by under-investing in mental health services while “pressuring people in mental distress to think about employment outcomes when they are simply not ready to do so”.

Peters said this results in mental health services being seen as “an unsafe space” and “a place of coercion and pressure to improve work outcomes”, leading people to disengage with services.

The ONS study was published as former New Labour minister Alan Milburn is set to publish his interim report this morning (Thursday) into the rising numbers of young disabled people not in education, employment or training (NEET).

He told MPs last week that he believes work can be a cure for the “tsunami of distress” affecting young people, and he appears to be set to recommend, in his final report later this year, that nearly all young disabled people – including those with significant levels of mental distress – will have to engage with DWP employment support programmes.

The ONS study was funded by the National Institute for Health and Care Research (NIHR), which itself is funded by the Department of Health and Social Care (DHSC).

The employment support tested in the study is funded by the Joint Work and Health Directorate, which is jointly sponsored by DHSC and DWP.

But neither ONS nor DWP nor NIHR would comment on the findings that showed the negative impact of talking therapy and employment support on long-term sick or disabled people.

ONS said the findings relating to those in employment suggest that “people in employment are moving to lower-paying jobs or reducing their working hours, among other lifestyle changes to manage their mental health”.

But ONS declined to comment on the figures showing the negative impact on those who were out of work and long-term sick or disabled, or on whether these findings suggest that adding employment advice to talking therapy can push disabled people with higher barriers to work further away from employment.

ONS suggested that NIHR, which funded the study, was better placed to comment.

NIHR told DNS that it was not appropriate for it to comment and questions should be directed to ONS and DWP.

DWP declined to say if it was surprised by the findings; how it explained them; whether adding employment advice to talking therapy can be damaging for many disabled people and push them further away from work; and whether ministers would take the findings into account alongside the reports from the Milburn review.

Instead, it said in a statement: “Employment advisors in NHS Talking Therapies is an innovative programme that ensures patients get the support they need to overcome barriers to work while receiving clinical treatment.”

It also said the following, which is not an accurate representation of the ONS findings: “We are pleased the ONS found it has had a significant impact on employment outcomes for those out of work – especially for those aged 18-35 – and we will apply these findings as we continue the roll out of WorkWell, which is due to help up to 250,000 people across the country.”