Is unemployment being rebranded a psychological disorder?

Issues around psychology and employment came to the fore during June, with a report on 'coercive strategy' in UK government workfare programmes, a demonstration against the placement of psychologists in job centres, and statements on the topic from the British Psychological Society.

Firstly, an article published in Medical Humanities suggested that people claiming unemployment benefits are being coerced in to undertaking psychological interventions. The research, which drew largely on personal testimonies, suggests unemployment is seen as a personal failure and psychological deficit.

Both authors of the paper, Lynne Friedli and Robert Stearn, are members of campaign group Boycott Workfare. This group works to stop 'work-for-your-benefits' schemes where people are made to work for free with potential sanctions on receipt of their benefits if they do not comply.

Friedli and Stearn suggest psychology is being used by the government to explain unemployment (that people have the wrong attitude for work) and as a means to achieve the 'right' attitude for job readiness. The report describes the role of 'psycho-compulsion' which it defines as the imposition of psychological explanations of unemployment and mandatory activities which are aimed at changing beliefs, attitudes and disposition. Friedli and Stearn write that some Workfare contractors that run training programmes, such as A4e, focus on psychological or 'soft outcomes' which treat gaining a job as something which can be achieved by having the right attitude. The authors write: 'Izzy Koksal, in her blog on the experience of A4e training, describes the impact of being surrounded by motivational quotes, with their persistent emphasis on individual responsibility for unemployment and the perils of negative thinking.'

They also refer to a recently-announced scheme in which claimants will undergo interviews which will assess whether they have a 'psychological resistance' to work, as well as profiling to test if they are ' bewildered, despondent or determined'. The people it deems to be less mentally fit, the authors write, will be given more intensive coaching than those viewed as optimistic – such as graduates or those recently made redundant.

A DWP spokesman told the BBC that Friedli and Stearns' report was not based on fact but rather anecdotal evidence from blogs and social media. 'We know that being unemployed can be a difficult time, which is why our Jobcentre staff put so much time and effort into supporting people back into work as quickly as possible. We offer support through a range of schemes so that jobseekers have the skills and experience that today's employers need,' he said.

The report also criticised the BPS, with the authors writing: 'BPS has confined itself to saying that such tests must be administered by experienced users of psychometrics under supervision of a chartered psychologist.' However, Professor Jamie Hacker Hughes, President of the British Psychological Society, responded with concern over the issues raised. He said in a statement: 'We are concerned at what the paper has revealed, particularly the issue of coercion to undertake psychological interventions. Friedli and Stearn suggest that unemployment is being rebranded as a psychological disorder, with an increasing range of interventions being introduced to promote a "positive" psychological outlook or leave claimants to face sanctions.' A later statement called for 'a dialogue with the government about applying psychological methods to public policy that emphasise best practice, trust, efficacy and appropriateness. There must be public confidence in psychology as a person-centred science. It should not be used for financial, political or ideological ends. … Individual wellbeing, not resource rationing, must be central to policy decisions about the use of psychology in the benefits system. We have yet to be assured this is the case.'

This report follows news in the 2015 budget that online CBT would be available to 40,000 claimants of Job Seekers' Allowance and Employment and Support Allowance, and that IAPT therapists would be located in at least 350 jobcentres by the end of the summer. At the end of June, psychologists and clients marched on Streatham jobcentre in protest over the plans. Back in March, the Department of Work and Pensions had announced that Streatham would be the first centre giving mental health support to help unemployed people back into work. Several groups, including Psychologists Against Austerity, attended the demonstration. One of their members, Dr David Harper, a Reader in Clinical Psychology at the University of East London, spoke to us about his long-standing concerns over what he sees as the 'anti-therapeutic' approach of the UK government (see below).

The Society has also released a Briefing Paper calling for thorough reform to Work Capability Assessments. This call to action highlighted a growing body of evidence that seriously ill people were being inappropriately subjected to these assessments, and said these do not effectively measure fitness for work and can produce inappropriate outcomes for claimants. It quoted the conclusion of the 2014 review by the House of Commons work and pensions select committee that: 'Simply rebranding the WCA by taking on a new provider will not solve the problems… This will be time consuming and complex, but the re-designed ESA assessment processes needs to be in place by the time a completely new contract, involving multiple providers is tendered in 2018.' The Briefing Paper called for the introduction of: a reliable, valid and fully researched method of assessment to replace the Limited Capacity for Work Questionnaire and the face-to-face Work Capability Assessment; appropriate training in assessment, scoring and interpretation for assessors; specialist assessors to assess people with mental, cognitive and intellectual functioning difficulties; supervision for assessors from qualified clinicians with expertise in rehabilitation, assessment and interpretation; appropriate referral routes for those with mental, cognitive and intellectual functioning difficulties, with specialist assessment and support; and appropriate periods of reassessment for people with long-term conditions based on specialist advice to accurately reflect the prognosis. 

BOX: Dr David Harper (Reader in Clinical Psychology at the University of East London) is a member of Psychologists Against Austerity. He told us:

"Professionals and service users concerned about the involvement of psychological therapists in job centres are not trying to simply deny people psychological help, rather, they are concerned about the way therapy is being introduced. The Conservative manifesto included a commitment to introduce de facto mandatory therapy: 'People who might benefit from treatment should get the medical help they need so they can return to work. If they refuse a recommended treatment, we will review whether their benefits should be reduced.' (see p.28).

Compulsory healthcare is reserved within society only for extremely serious situations (e.g. managing epidemics or where someone poses a serious risk to themselves or others or where someone has committed a serious violent criminal offence) and where there is legal oversight. Reviewing someone's benefits for failing to take up therapy in relation to job-seeking seems an entirely disproportionate and probably counter-productive move.

It is worth noting there has been little coverage of the evidence base for the government's policies. An evaluation has been published of the pilot sites. Even within its own assumptions the outcomes were poor and had a very high drop-out rate: of 413 referred to the four pilot sites, 173 dropped out. The high drop-out rate may be one of the reasons the manifesto suggested that benefits should be refused if people didn't take up opportunities for help, but there is relatively little insight into why drop-out rates were high (see bottom of p.6) and there was no systematic research into the experiences of those receiving or declining therapy.

Of the 240 left in the pilot, only 15 got jobs (a success rate of 6.25 per cent). Forcing therapy with such a low success rate is disproportionate' Placing the onus for unemployment on individual unemployed people seems to be a case of blaming the victim. Levels of unemployment are partly due to the government's own austerity policies and many economists have criticised the government for not adopting policies focused on economic growth (as they have in the USA, Iceland, Germany and elsewhere)."