Surviving the siege

The Austerity Policy was introduced in 2010 after the financial crash of 2008. My aim here is to outline the contribution psychology can make toward alleviating the impact of the policy on vulnerable citizens.

It might be argued that the present situation is not a new one, and is like the economic recession of the 1930s (described in such accounts as George Orwell's The Road to Wigan Pier, published in 1937). However, this is incorrect. Then, unemployment was framed as an economic consequence of the world-wide recession. Similarly, in the post-war period, David Kynaston in his exhaustive Austerity Britain 1945-51, describes a system of rationing of materials, such as food, which applied to each citizen equally. There was a flourishing black market for those who could afford its prices, but each person started out from the same place – with a ration book. To my eyes, the present Austerity Policy clearly has different purposes. It makes no attempt to discomfort the rich and attempts to minimise payments to the poor, independently of the suffering thereby caused. The need for the Austerity Policy is 'explained' by the official narrative that the unemployed are 'shirkers and scroungers'.

The 'shirkers and scroungers' narrative is false. In fact, the largest groups of people drawing benefits are, firstly, pensioners, and, secondly, those who are working, but who cannot live on their wages. These groups are part of the precariat, to use Guy Standing's term, which he defines as consisting of people whose condition of existence lacks predictability or security, affecting their material and psychological welfare. 

The number of people drawing benefits who are working outnumber those who are unemployed. However, many of those working are so poorly paid that they cannot live on their wages, and therefore the Government provides a subsidy, via tax credits. Indeed, in understanding the precariat, the problem of under-employment (being offered too few hours to permit any financial security) is more important than the problem of unemployment, especially as the under-employed are not registered, being considered as being 'in work'.

A major factor in being part of the precariat is being on zero hour contracts, or some version thereof. Zero hours employment is very widespread – the Office for National Statistics estimated 883,000 persons were on zero hour contracts in September, 2017, but there are almost certainly tens of thousands more on similar contracts. Aditya Chakrabortty and Sally Weale (The Guardian, November 16, 2016) overviewed surveys that showed that 53 per cent of university staff are on some form of insecure, non-permanent contract; and three quarters of junior academics are on such contracts.

A third group affected by austerity are those disabled physically or by mental health problems. In the last few years, mental health services for children and adolescents have been savaged. The 'Bedroom Tax' (part of the Welfare Reform Act, 2012) affected an estimated 660,000 working age social housing tenants (Moffatt et al., 2016), the North-East of England being disproportionately affected. It was particularly damaging to the disabled, as the 'spare' room might well have been needed for equipment, or for a spouse/ child to sleep in if the disabled person needed help in the night; or for a carer to stay overnight. Since an inability to live on the decreased benefits could put the disabled person at risk of needing expensive more intensive, professional care/support, it was both particularly callous, as well as quite self-defeating in terms of overall financial savings (which suggests that it is part of a different agenda). This group is attacked in the media, as well as quite often abused in the streets, as cheats who have exaggerated their conditions and are making fraudulent claims. Because they desperately want to hold onto their existing housing, quite often converted at their own expense, many of those affected by the cut in their benefits have limited their food intake, and/or given preference to feeding their children (Moffat et al., 2016). Despite the inevitable consequences of the legislation, when it was launched in 2012, the Government's Impact Assessment, cynically and without supporting data, stated that it would have no impact on health or wellbeing. (Psychologists studying communication could help us understand the position and function of words such as 'scrounger', 'benefit cheats' etc., as opposed to those who 'aspire'.)

A less visible aspect of the lives of all these groups is the poverty premium – 'the extra cost people on lower incomes typically pay for goods and services, compared with what is paid for the same goods and services by people on a higher income … [for example, car insurance may well cost double] … a typical low-income family could face an annual poverty premium of around £1,700 for everyday goods and services' ('Feeling the Pinch', p.10).

The figures are almost too large to comprehend. In the UK, 3.9 million people, of whom 2.3 million are children, are living in poverty, despite at least one parent being in work. A survey by Shelter in August 2016 reported that 16.5 million people had no savings whatsoever and that one in three working families could not afford to pay their rent or mortgage for more than one month, if they lost their job. The effects have been most severe in the poorest parts of the country (Barr et al., 2015).

Need

As Abraham Maslow showed many years ago, any human being needs safety, shelter, warmth, the means of keeping oneself clean, to be able to clothe oneself, and, of course, food.

For food, we have some statistics. The Trussell Trust, a non-government body which co-ordinates food banks across the UK, was operating food banks in 29 local authorities in 2009-2010. By 2013-14, this figure had risen to 251 local authorities. In six months in 2014, half a million people received a food package from the Trust, and the all-party parliamentary group on food poverty estimated that at least as many independent food banks again were in operation (Loopstra et al., 2015). These already high figures are almost certainly an underestimate of real need – Moffat et al. (2016) found that many people do not know of the existence of food banks, and of those who do, many will not use them from shame.

The government's white paper, published in February 2017, stated that 57,750 households were homeless, up six per cent from the year before. According to the Joseph Rowntree Foundation, 275,000 families approached their local authority for homelessness assistance; and the government street count in 2016 estimated 4,134 people sleeping rough, double the number since 2010. Informed charities considered that a serious under-estimation as homeless people are often not visible.

Life and death

The philosophy behind austerity has been applied to both the NHS and social care. In a 2017 paper (Watkins et al.) a group of ten researchers from the universities of London, Oxford, Cambridge and the Philippines, looked at death rates since 2001 and concluded that these cuts 'were associated with nearly 45,000 higher than expected deaths between 2012 and 2014. If these trends continue, even when considering the increased planned funding as of 2016, we estimate that approximately 150,000 additional deaths may arise between 2015 and 2020. Combining … [this] translates to around 120,000 excess deaths from 2010 to 2017.' Persons aged ≥ 60 years were most susceptible, and deaths in care homes and at home contributed more to the total than deaths in hospital. The routes to such increased mortality would include lack of nourishment, leading to decreased resistance; using cheaper foods, high on carbohydrates and sugar, leading to health risks; and lack of heating, causing or exacerbating respiratory conditions. This study replicates earlier work by Hiam et al. (2013). If 120,000 persons died in a war zone, as a result of a government's hostile actions, one would ask whether this was a war crime. What is the legal term if it happens in peacetime, through intentional neglect of 'unproductive older adults'?

The effects on people's mental health are clear-cut and consistent. GPs, with no ability to change the political situation, may prescribe anti-depressants. The rise in anti-depressant scripts has been inexorable. In 2005, there were 29.4 million scripts and in 2006, 31 million. By 2014, the number had shown a large increase to 57.1 million, by 2015, 61.0 million and the figure for 2016 was 64.7 (All figures from the annual report of the Health and Social Care Information Centre).

Being out of work has a devastating effect on well-being. Barr et al. (2015, p.327) showed that 'the prevalence of reported mental health problems was far higher amongst people out of work compared to people in work – approximately 10-15 percentage points in 2004 and this gap increased over time'. Antonokakis and Collins (2015) studied data from five Eurozone countries – Greece, Ireland, Italy, Portugal and Spain – from 1968-2012. They concluded that 'a one percentage point decline in a Eurozone periphery country's growth rate increases suicide rates of the population across all ages by 0.9%, and by the population between 10 and 44, and 65 to 89 years of age by around 1.3%' (p.68). The figures for men were significantly higher than for women.

Developing psychological approaches

The data from mental health investigations are clearcut and telling. However, they are aggregates of large numbers, and therefore can become mind-numbing. They do not allow us to get near the human experience of the effects of the Austerity Policy. I have, therefore, drawn on my experiences of volunteering in a food bank, personal accounts and the existing literature, to outline a model, firstly of experienced emotions and then of cognitive structures.

Besides aiming at a more individual approach, another purpose of this model is to show that the emotions generated by living under a state of siege are understandable responses, and not part of some diagnosable mental condition.

A psychological approach must provide understanding at two levels. Firstly, there are 'attacks on the person', where the person fears they will be unable to achieved the basic conditions of living just outlined and may well fear for their continued existence, and certainly for any quality of life.

The second level concerns the threats to their psychological well-being, which centre on feeling in control of one's life through the maintenance of one's self-narrative.

Attacks on the person

Attacks on the person concern threats to their continued health, if not their very existence, and therefore understandably generate very strong emotions.

Not surprisingly, the paramount emotion generated by attacks on the person is fear. We can distinguish between fear and anxiety because fear 1) has a definite object that is the cause of the person's apprehension, and 2) often, but not always, has a base in reality.

An example of realistic fear is the switch to Universal Credit. This process routinely takes five weeks and often more. How a person on the bread line is expected to survive for that period is an unanswered question. The amount they will receive, when they eventually get their Universal Credit, will be less than the sum of their previous, separate benefits. Additionally, direct payment of rent to landlords, ensuring some security of accommodation at least, has been withdrawn.

Another source of realistic fear is from unexpected situations. For example, many of the precariat, especially in rural areas, need their cars as the only form of transport available. But cars break down, especially when they are old, and are costly to repair. Another constant fear is among those with dependents. Children fall ill. Then, unless they are part of a strong support system, one parent must take time off work. Besides the loss of income, there are many accounts of people being financially penalised and having to pay the cost of a replacement, or even losing their job. Besides child care, many people care for ill partners or frail parents, so suffer the same fears.

Also observable will be the experience of panic, when fear about the future becomes uncontrollable.

What can result is a continual state of dread, which has often been reported by people called in for re-assessments of their Personal Independence Payment (PIP). This is a realistic response, since between October 2013 and October 2016, 22 per cent of Disabled Living Allowance claimants with mental health conditions had their benefits reduced when they were reassessed for PIP and a further 25 per cent lost them altogether (Lavelle, 2017).

The arbitrary nature of these decisions is shown by the fact that 'complaints about the PIP rose by 880% last year. The number of complaints that were upheld rose similarly dramatically by 713%' (Lavelle, 2017, p.7). This is because, if the claimant persists for long enough, their case will go before an independent tribunal, where their submitted medical and/or psychological evidence, will, for the first time, be considered carefully. But this eventual achievement of justice must not be used to disguise the months of living on a much reduced income.

Damage to the person's sense of being in control of their lives and the predictive utility of their self-narrative

Turning to cognitive structures, George Kelly, one of the great, unrecognised geniuses in psychology, in his 1955 work, The Psychology of Personal Constructs, saw the ability to predict one's future as the central keystone of a person's functioning. It was the inability to predict and/or distortions in the accuracy of prediction that caused dysfunctional behaviour. What characterises the Austerity Policy is the deliberate use of power to continuously undermine the person's ability to shape their future.

Claimants, are likely to believe, correctly, that they are not in control of their lives, and, therefore, they cannot control their future, in which unpleasant things will inevitably happen. Decisions regarding their employment may well be made by the Job Centre, independent of their wishes. Ideas that they may have for improving their situation, especially if they require money to get started, cannot be acted on.

The inability to predict, and thereby control one's life, leads inevitably to a sense of hopelessness. This state is self-reinforcing since the hopeless person does not believe that they can effect change; and that future is as bleak as the present. But given their situation, it is a realistic emotion. As a result, there will be a severe loss of self-esteem and, again realistically, a greatly increased sense of powerlessness.

Furthermore, the officials' decisions often seem arbitrary and thereby, unpredictable, further undermining the person's ability to be in control of their life. The concomitant emotions are chronic, near continuous anxiety, frustration and anger.

Not surprisingly, with this loss of control over their lives, comes risk-aversion, the avoidance of any change, since using one's own initiative may well get punished.

Finally, given the very strict controls required on their restricted finances, it is likely that there will be apparently irrational behaviours such as impulse spending on non-essentials as a form of (temporary and ultimately self-defeating) self-comfort.

Turning to the person's identity, another effect of the Austerity Policy is that the self-narrative becomes very fragile. A person's identity is carried by their self-narrative – their self-constructed autobiography, which explains how they became who they are. A person's sense of continuing identity is a key component of their sense of well-being.

An important aspect of the self-narrative is that it is offered to others as a persona that they will respect and negotiate with or around. In contrast, when dealing with government agencies, those agencies' definitions of reality are the only ones that will be acted upon. The client, on leaving such an interaction, may well experience despair because their identity has been attacked, and replaced by being seen as a member of a worthless, highly- stigmatised group.

The intervening variable that leads to the acceptance, to a greater or lesser extent, of this label is shame – that such a label is justified because one has failed in one's basic tasks: not having a job, or not having succeeded in finding a sufficiently well paid job, failed to clothe and feed one's children, failed to keep up with the rent – 'failures', in short, that result in feelings of worthlessness and a pervasive sense of shame, thereby permitting the internalisation of the stigmatisation.

This loss of sustaining self-narrative can happen quite quickly, as a life or health event causes the person to lose their job and the Benefit System fails to provide any safety net to give them time to either find new employment, or, at least, adjust to their new situation.

The attacks on the self, coupled with continual financial insecurity, lead to tensions in the person's interactions with key others, such as partners and/or their children. In a consumer society, part of one's worth is being able to buy goods for oneself, one's family and friends but they do not have the financial resources to fulfil such a role. So, many will experience a diminution of their social network, be it in the quantity and/or strength of its bonds. They may have to move away from friends and family to find work. As Moffat et al. (2016) found, when undertaking interviews with those affected by the Bedroom Tax, this can lead to loss, or diminution, of valued roles, such as grand-parenting. It may be quite beyond their means to return for family visits or important family rituals; or to offer hospitality, whether inside or outside the home, limiting their capacity to make new friends.

The monitoring aspect of the Austerity Policy also has an impact. A person whose condition fluctuates may well hesitate to go out on a 'good' day for fear of being reported as a benefit cheat.

The dismantling of one's face-to-face network makes effective complaining about the local system, such as through local action groups, more difficult.

There has also been a destruction of professional networks that, previously, the person could rely on to provide a trusting, caring, on-going relationship from a person with the relevant skills. A person is likely to be seen – if they are seen at all – by various members of the team, thereby decreasing the strength of the bond. Clients with high levels of dependency complain of having to interact and explain themselves and their situation to multiple carers.

What can psychologists do?

Preventive work and early intervention – before a condition, and the person's responses to it, become chronic – would clearly be cost-effective. A crucial component is helping people to regain some control of their lives. Training courses in stress management but also, at the same time, a citizen's statutory rights, would help claimants to understand the system in which they are enmeshed. Such a two-pronged approach might help people locate more of the causality in the system rather than their own frailty; and assist them in dealing with the high levels of stress engendered as effectively as is possible. An understanding of Goffman's concept of repairing spoilt identities, developed in Stigma: Notes on the management of a spoiled identity (1963) may be useful.

Research has shown that residential stability, civic engagement, trust and social cohesion are important community-level resources for mental health and wellbeing (e.g. Houle, 2014). So, by teaching in groups that could then mutate into support groups, fear, anxiety and felt isolation might well decrease as supportive bonds develop between the participants. Together, people might be able to resist stigmatisation, at least to some degree, thereby regaining some self-esteem and self-worth. They would also have access to skills-sharing, to increase their chances of successful negotiation of the system.

Such groups should emphasise their non-clinical nature, as claimants may well, correctly, reject any association with mental illness. A key aspect would be focussing on, and understanding, the nature of the system that they are caught up in. One facet, for example, should be 'hanging on in'. It is possible to successfully appeal a PIP assessment, as cited earlier (Lavelle, 2017, p.7). But claimants need sustained support to keep on withstanding the attacks on their wellbeing and to keep challenging the decisions. So, groups will need to be open-ended, not time limited, to provide that support, perhaps changing from training to self-help groups. They will continue to need professional input to provide prestige support and professional knowledge of the system.

For those who have experienced a breakdown in their mental or physical health, clinical interventions will need to include an explanation of the rationality of their emotions to help them stop blaming themselves and see their reactions as, in large part, due to the external stresses they have been facing. By providing a much more neutral framework, it may be possible for them to work through some of the incorrect attributions they have internalised, and realise their essential self-worth.

Again, groupwork, rather than individual approaches, will make it easier for the members to see that they are not alone, and gain support from each other.

A starting point

Psychology has an important contribution to make to both understanding and alleviating the effects of the Austerity Policy. This article proposes an approach that can be relatively easily operationalised and subjected to empirical research, to increase our understanding of the relevant processes. But more importantly, it suggests interventions that take due account of the all too real assaults that some of the most vulnerable of our citizens are sustaining at the hands of the State. Ferraro (2016) has accused clinicians of implicitly acting out the assumptions and stigmatisation of the dominant political narrative. I would hope that this is not the case; that this article has highlighted the very damaging effects and consequences of the Austerity Policy on the lives of millions of people and their children; that it has offered a starting point from which to research their experiences and emotions; and will encourage psychologists to become involved in the alleviation of its effects.

- Dr Mike Bender is an Honorary Fellow at the University of Exeter. [email protected]

References

Antonakakis, N. and Collins, A. (2015). The impact of fiscal austerity on suicide mortality: Evidence across the 'Eurozone periphery'. Social Science and Medicine,145, 63-78.

Barr, B., Kinderman, P. and Whitehead, M. (2015). Trends in mental health inequalities in England during a period of recession, austerity and welfare reform 2004-2013. Social Science and Medicine, 147, 324-331.

Dwyer, P. and Wright, S. (2014). Universal Credit, ubiquitous conditionality and its implications for social citizenship. J. Poverty. Soc. Justice, 22, 27-35.

End Child Poverty. Feeling the pinch. London: End Child Poverty, 2017

Ferraro, D. (2016). Psychology in the age of Austerity. Psychotherapy and Politics International, 14(1), 17-24.

Goffman, E. (1963). Stigma: Notes on the management of a spoiled identity. Englewood Cliffs, N.J. Prentice-Hall.

Hiam, L. et al. (2013). Why has mortality in England and Wales been increasing? An iterative demographic analysis. J R Soc Med., 110, 2017, 153-62.

Houle, J.N. ( 2014). Mental Health in the Foreclosure Crisis. Soc. Sci. Med., 118, 2014, 1-8.

Kynaston, D. (2007). Austerity Britain 1945-51. London: Bloomsbury.

Lavelle, D. (2017). "I just exist between appointments. I have lost hope." The Guardian G2, 01.11.17: 6-8.

Loopstra, Rachel et al. (2015). Austerity, sanctions and the rise of the food banks in the UK. British Medical Journal, 2015;350: h1775

Moffat, S. et al. (2016). A qualitative study of the impact of the UK 'bedroom tax'. Journal of Public Health, 38 (2), 2016, 197-205

Savage, M. et al. (2015) Social Class in the 21^st Century. London: Pelican.

Standing, G. (2011). The Precariat: The New Dangerous Class. London: Bloomsbury.

Watkins, J. et al. (2017). Effects of health and social care spending constraints on mortality in England: A time trend analysis. BMJ Open, vol. 7 (11), 2017.

Acknowledgements

I wish to thank Alison Bender, Gilly Constance, Richard Hallam, and Tony Wainwright for his help in the gathering of background material.