The Work Capability Assessment has been ruled as unfair and “significantly disadvantages” those with mental illness by a group of judges following a tribunal. Whilst I have written about an aspect of this in a previous blog, what is of enormous concern to me is how we got to a place where, both governmentally and societally our attitudes towards those with disability and mental illness, in some respects, have regressed to a frightening degree, what our expectations are of those with mental illness (of which this blog focuses on, and which the ruling, in it's criticisms of mental illness and the Work Capability Assessment (WCA) also focused on), and how, over only a few short years, mass opinion, mass populace, have lost it's empathy, it's mindfulness and most importantly, it's insight in to the lives of people living with a mental illness. This blog isn't about what percentage of the budget is spent on the mentally, which I've covered in previous posts. This is about how a scary majority have slammed the door in the faces of people who's suffering can often be unimaginable to those unburdened by mental illness.
When we look at how mental illness was dealt with right up to the early 1990's and slightly beyond it in some areas, we can see the “old” model of caring in place. And “old” is an appropriate word, because it was based on institutionalisation and what were colloquially known as “Mental Asylums”. Mental Asylums were purpose built from Victorian period up to the Edwardian period, as interest in the fields of psychiatry, which had begun in the early 1800's and exploded when Sigmund Freud came to prominence. However, long before this, Bethlem at Moorfields in London opened 1676, which catered for 100 patients, and a few other institutions followed in the years directly after this, notably in Norwich and Newcastle Upon Tyne. These “Bethlem” modelled institutions were literally called “Mad Houses”. In the intervening years, many provincial “Lunatic Asylums” opened – many lacking doctors and run more as prisons than in any way as places of respite or rehabilitation.
History also overlooks literal “care in the community”. Many mentally ill people were looked after by their families or communities, going as far back as Medieval times. Pathology and illnesses – of the mind and body right up to beginning of the 20th Century were in many areas “unknowns”. There were many causes of mental suffering – thyroid problems, Alzheimer's were there then as they are now, along with a litany of ailments that could cause mental illness. Even a bladder infection could, and still does cause psychiatric issues if left untreated.
But the modern “old” (if that makes sense) institutions, that many alive today will still remember had they been residents or employees in these places was borne out of the Victorian model of asylums, and was revolutionised by a man called Robert Gardiner Hill from Lincoln, England. He came up with a treatment system that universally “worked” on all patients, so the previously common practice of mechanical restraint and coercion could be done away with entirely. These inhumane devices were quickly made obsolete, and this had a direct impact on the way institutions housing the mentally were built. In fact, creating mental institutions became something of an art-form, and by 1900-1910, few, if any, towns were devoid of a mental institution. However these places themselves became a part of folklore, and were feared, “they'll take you away to the asylum!”
At the height of the building explosion in mental institutions (they weren't called hospitals in many cases until the 70's and 80's, something of them retaining the “Asylum” suffix in the same manner), these places became ever more Byzantine and labyrinthine in design. Here are a two floor plans from that era:
At first glance, they almost look like floor plans for stately homes, indeed, so did their exteriors. However, apart from a few exceptions, most of these hospitals were found at the end of long winding drives, hidden behind mountains of Rhododendron bushes – well away from the public eye. Here are two exterior shots. The top image is High Royds Mental Hospital in Leeds, Yorkshire.
The philosophy behind buildings like these was well intended. Having been in a couple of long abandoned institutions similar to this myself, it's clear these hospitals had limited facilities and an extremely limited palette of treatment options for the ill. They were strictly divided between male and female – this is why we see the kind of symmetry in the floor plans. Ideas about how the mentally ill should be treated would be viewed as deeply questionable, but one has to remember these buildings were in place at the same time chimney sweeps of eleven and twelve were being pushed up 60ft chimney flues. What is critical to remember here is that whilst this system was not right, it was recognised without fuss, that those who were ill were a responsibility of the state and of charitable trusts. It was simply accepted. There can be no denying this system was the wrong system – people were institutionalised because they had children out of wedlock – it was seen as “feeble minded”, and many thousands of people who may well have had cause for hospitalisation for a period of time found their whole life stolen by these hospitals. The point I am making here is simple, the house they built was all wrong, but they recognised that some people could not work. The problem was that they didn't recognise that many people get better, or become stable and were never again given the chance to become valuable or wanted members of their community.
With the introduction of the National Health Service shortly after WWII, the notion that those who could not work due to illness, and were therefore society's responsibility became even more accepted. One would not have brooked the kinds of situations we see today where severely mentally ill people, by dint of the Work Capability Assessment must job search, when they struggle to get out of bed, or fill out a form. But this is where the good intentions of “Care In The Community” in time turned on the very people it was supposed to shelter. Care in the community only works if care is being given. From the start that care was patchy, but it's intentions were exactly right.
If we move forward to today and take an example of a man with paranoid schizophrenia, who is already not getting adequate monitoring or “care in the community”, and he's faced with the Work Capability Assessment, which then finds him capable of work when he is simply not capable of operating in a working environment. His GP agrees, his psychiatrist agrees. But every year he has to jump through the WCA hoop to retain a benefit that just keeps him pushed under the poverty line. He's been told that he will never be capable of work. He is an extremely ill man. Yet he is hounded and through the spin of the government he has been thrown onto the pile of shirkers and malingerers. Have you ever been with a person with Paranoid Schizophrenia when they are actively seriously unwell and going through a period of psychosis. Perhaps. But why not leave Alex alone. Yes he's a real person. He's my old next door neighbour. Why risk making his illness worse through forcing him to attend assessments when he hasn't filled the form in properly? Why don't they take the doctor's word for it? Or the psychiatrists? If you want to save some money, why don't they start by trying to get a few trillion back in unpaid taxes instead of trying their hardest to deny this man £112 a week? Because that's his reality. A reality few would choose.
The next time you see headlines about “shirkers” or people “swinging the lead” and there's an article about ATOS, WCA or Employment Support Allowance, It might be worth reading it. Before my mental illness became so severe that I couldn't work I had paid my taxes, and when I'm well enough to work again, I'll do the same. That's how the Welfare State should work. Instead people, mentally ill or not are being told they must “earn” their benefits when, in many cases they've already paid for them in tax. We risk becoming an intensely apathetic and cold-hearted nation if we choose to take spin and propaganda at face value. The employed are the lucky ones, but they forget that almost 70% of all benefit claimed is done so by the employed, leaving aside the amount we pay out in pensions. When I was 23 I never believed I would develop a serious mental health disorder. At 30 I never believed I would have a stroke just a year later. Nobody knows what's around the corner. I used to think about myself all the time until I became ill, and weirdly, when you get ill you start thinking of other people. And that mantra “Do As You Would Be Done By” becomes not a life choice but an obligation.
