Suicide Rates rising due to redundancy & poverty

In the last couple of days disturbing stories have emerged of people killing themselves due to the current austerity. In one case a man is thought to have killed himself after being made redundant (see here). In another, a couple killed themselves in a suicide pact because they could not cope with poverty (see here). It is known that women in poverty are 15 times more likely to commit suicide (see here). It is with this in mind that one of my regular readers asked me to investigate whether or not suicide was indeed on the rise. I must say at the outset, that a) there are no 2011 figures for suicide yet and b) there is no way of ascribing motivation to abstract ONS statistics on suicide c) Experts are sceptical that recessions lead to increased suicide. Thus, any trends recorded my be simply coincidental. Nevertheless, the data is presented below.

According to the office of national statistics, the % of male deaths resulting from intentional self harm (suicide) as a proportion of the overall deaths resulting from injury and poisoning reached a four year high in 2010. We cannot know the motivation for these men who committed suicide, simply that as a proportion of external deaths, they have been rising.

According to the office of national statistics, the % of female deaths resulting from intentional self harm (suicide) as a proportion of the overall deaths resulting from injury and poisoning reached a four year high in 2010. We cannot know the motivation for these women who committed suicide, simply that as a proportion of external deaths, they have been rising.

The question is this; why is it that suicide is increasingly forming a larger portion of deaths resulting from injury or poisoning? Suicide levels have, generally speaking, been falling fairly steadily since the 1970s. Indeed, suicide rates up until 2007 were in quite steady decline. The question is this, why has this trend been halted, or dare I say it reversed?

Experts in the field have complained that the ONS are underestimating suicides by up to 6% in the last couple of years due to the increased recording of narrative verdicts by coroners. (see link). The Evening Standard have speculated that the increase could be linked to economic pressures. The Independent, also reached the same conclusions.

 

Source

Welfare reform and the US insurance giant Unum

The extraordinary announcement that GPs may no longer be able to sign their patients off work for periods longer than 4 weeks, offers an insight as to corporate involvement which underpins the policy decisions of neoliberal governments. There are doubtless many shades of understanding and levels of cynicism amongst both the supporters and the protagonists of these policies, but there are certainly those who know exactly how to deliberately spin the narrative to achieve the desired financial outcome for the ‘markets’. This post attempts to draw out some of the strands.

Lord Freud, Minister for Welfare Reform, has announced a new way in which this government can potentially deter the disabled and long-term sick from claiming benefits.  No longer would the GP be able to sign patients off work for longer than 4 weeks.  After that period, the professional expertise of the medic would be subject to an independent assessment, presumably by the highly questionable tick list/points system used by a private contractor such as ATOS.  Furthermore, according to a Guardian report  People who are signed off sick would also be put on to jobseeker’s allowance, rather than employment support allowance, for a period of three months. They would receive less money and have to prove they were looking for work.

So yet another tranche of ill and disabled people would have to comply with an inappropriately structured assessment with all the attendant worrying, potential exacerbation of symptoms and travel expenses; not to mention additional costs to the tax-payer, that such a superfluous assessment entails.

Labour MP Dennis Skinner said: “Last year, the government said GPs should be accountants in charge of the money that is spent in the NHS. This year they want assessors to be GPs. It’s crazy. No wonder the country is going to the dogs.”

So why are we being told that, on the one hand, the GPs are the right people to determine the spending of billions of tax payer’s money on health commissioning, notwithstanding their lack of expertise, but that they cannot be trusted to use their professional judgement in assessing a patient’s health and/ or the need for a referral to occupational health?

One answer is to ‘follow the money’.  The medical profession diagnose some patients with intractable long-term illnesses like Fibromyalgia, Chronic Pain, Lyme Disease, Myalgic Encephalomyelitis (ME), and so on…  all of which could prove ruinously expensive for private health providers like the US employment protection insurer Unum.

‘Unum’s 1995 ‘Chronic Fatigue Syndrome Management Plan’ sounded the alarm: ‘Unum stands to lose millions if we do not move quickly to address this increasing problem’

Unum (www.unum.com) is one of the leading providers of employee benefits products and services and the largest provider of group and individual disability income protection insurance in the United States and the United Kingdom.

Unum’s close involvement with Welfare Reform, politicians, psychiatrists, academics and think tanks is well documented, and arguably can be likened to the tentacles of the Goldman Sachs squid extending across European governments. http://think-left.org/2011/11/07/the-market-has-a-name-it-is-goldman-sachs/

Unum’s UK activity since the 1990s is referred to in:
http://think-left.org/2011/08/04/welfare-reform-and-mecfs/
http://www.lwbooks.co.uk/journals/articles/rutherford07.html

But in addition, Private Eye has also raised questions about Unum’s involvement with the DWP (Department of Work and Pensions).

The Eye first questioned Unum about the possibility
of a serious conflict of interest back in 1995… Tricky questions are again being asked about the profits American insurance
giant Unum stands to make from its massive media push on income protection
cover, promoted as the answer to the latest tough welfare
reforms …..
Meanwhile disability activists who have fallen foul, and been forced to appeal
cuts in DWP benefits based on flawed Atos assessments, and campaigning groups
like Black Triangle, think the whole thing stinks and are urging MPs to
investigate.
http://victimsofatoscorruption.wordpress.com/2011/11/10/private-eye-magazine-asks-questions-again-about-unum-dwp/

It is clear that there is a ‘happy match’, a common objective, between the neoliberal political view of benefits, and the interests of private health insurers.  The neoliberal politician wants to shrink the State and reduce public expenditure via privatisation, and the private health insurer wants to maximize profitability by not having to pay out for any claims.  Both, therefore, want to remove people from benefit entitlement and, to that end, working collaboratively within the DWP would clearly make ‘sense’.  Unfortunately, neither the agenda of the politician, nor the health insurer, address or include the actual reality of diverse problems of ill health and the myriad of difficulties faced by sufferers … and as has been described there are several million sufferers of intractable long-term illnesses and permanent disabilities. In effect, the DWP agenda is motivated towards denying ‘illness’ and associated legitimate need, wherever possible.

In order to bridge this gap between the policy makers and reality, a narrative must be constructed which is both compelling and achieves the common objective without it being obvious that the real agenda is privatization and withdrawal of public expenditure.  The narrative chosen usually attributes some innate characteristic to a particular group.  For example:

‘GPs are our most trusted members of society and know what is best for their patients…  therefore they should do healthcare commissioning for the NHS’

‘GPs are too emotionally involved and do not know what is best for their patients … therefore, we need an ‘objective’ assessment.’

However, the underlying assumptions about illness upon which the DWP predicate their actions seem to have slipped out in the following quote:

Justifying the new proposals, UK’s national director for health and work, and the former head of the British chambers of commerce David Frost, said when people were off sick for longer than four weeks they started “to lose the will to work” 

Anything more than cursory consideration, indicates that this is a ludicrous and totally unsubstantiated statement.  All people become work averse after 4 weeks of being so ill that the GP considers them unfit to go to work? Where is the evidence for such an assertion? It is not even clear how it would be possible to validate such a claim scientifically.

However, this statement is consistent with the biopsychosocial model of illness which needs to be explored more fully in another article.  Suffice it to say that this Orwellian model redefines ‘illness’ and was created by ‘psychiatrists and academics … happy to draw on their moral authoritarianism and neo-liberal policy prescriptions (and unmentioned links with Unum) to produce a monograph, The Scientific & Conceptual Basis of Incapacity Benefits (TSO, 2005, Waddell and Aylward) which was published by the DWP, and provides the intellectual framework for the 2006 Welfare Reform Bill (1).
The proposition, “to lose the will to work” amply indicates one of the moral panics of authoritarianism that human beings only behave ‘properly’ if offered ‘the stick or the carrot’… ie. people will pretend to be ill to get out of work if given the opportunity.

This view of humanity or ‘model of man’ underpins both neoliberal policy decisions and the justification for the so-called ‘free-market’.  The nature of ‘Man’ is perceived as innately self-interested, greedy, and wanting to ‘pull a fast one’, unless they are restrained by laws or offered incentives.  That it is considered to be innate, and therefore immutable, justifies both taking advantage of others to get the best deal, and the imperative to punitively control the other to prevent having that advantage taken away.  Hence, we have a one-sided neoliberalism.

‘..neoliberalism has not so much been about increasing wealth, but about redistributing it.
http://think-left.org/2011/10/14/capitalism-neoliberalism-plutonomy-and-neo-feudalism/

Unsurprisingly, given the lack of fit with reality:

‘The work capability assessment programme, which assesses benefit claimants to see whether they are fit for work is “teetering on the brink of collapse” as the system becomes clogged up with appeals.’
http://www.guardian.co.
uk/politics/2011/nov/21/benefits-appeals-system-near-collapse

Appeals have quadrupled, and Citizen’s Advice Bureau’s are inundated with people seeking advice on how to appeal.

It is clear that the changes and cuts made to the benefits system are based on the interface of ideological, psychological, political and financial factors, and are simply not tenable.  The appalling impact of these ‘welfare reforms’, ungrounded in reality, are only now beginning to come to light with tragic reports of suicides http://diaryofabenefitscrounger.blogspot.com/2011/11/latest-disability-news-roundup.html but little reported in the mainstream media are the increased levels of hardship, worry and deprivation for the disabled and long-term sick whom the overwhelming majority of the population would wish to support.

Somewhat horrifyingly, these facts are used to the advantage of Unum UK in their advertising ploys:

McGarry,
chief executive at Unum UK, earlier this year warned: “The
 government’s welfare reform bill will seek to tighten the gateway to benefits 
for those people unable to work due to sickness or injury. Each year up to 1m 
people in the UK become disabled and the reforms mean that working people will 
be able to rely less on state benefits to maintain the standard of living they
were used to prior to their illness.”
http://victimsofatoscorruption.wordpress.com/2011/11/10/private-eye-magazine-asks-questions-again-about-unum-dwp/

So, Unum warns people to get insured against the cuts in benefits … of which they, Unum, were major architects …. either directly as advisory consultants, or through their funding of psychiatrists who created the intellectual framework, the funding of think tanks and academics who in turn recommend policies to the DWP, and  by offering ‘jobs for the boys’.  For example, by funding the 1.6m  UnumProvident Centre for Psychosocial and Disability Research at Cardiff University, and appointing Mansel Aylward (the former DWP Chief Medical Officer and co-author of the DWP  biopsychosocial monograph) Director of the unit..

It is hard to believe that there are not some very hard-headed individuals in Unum who are not fully aware of the heist that they have perpetrated.

It should be noted that there are many other private health providers who have doubtless played a similar role in creating Lansley’s new model for the NHS…

However, it cannot be avoided that many of these policies stem from New Labour’s period in office.  It is particularly noteworthy that a common link is provided by Lord Freud who switched from New Labour to the Conservatives in 2009, having been appointed by Tony Blair to provide an independent review of the British welfare to work programme in 2006, and then rehired as an adviser to the government when James Purnell was appointed Secretary of State for Work and Pensions in 2008.  A former journalist for the FT, Freud became the vice-chairman of investing banking at UBS AG until his retirement in 2003.  His expertise in disability or long-term illness is rather notably absent but his background in asset management and financial structures is clearly impressive.

UBS AG (SIX: UBSN, NYSE: UBS) is a Swiss global financial services company headquartered in Basel and Zürich, Switzerland, which provides investment banking, asset management, and wealth management services for private, corporate, and institutional clients worldwide, as well as retail clients in Switzerland.  (Wikipedia)

In order to become Real Labour, Ed Miliband and his team must draw a clear line away from New Labour’s policies, and devise a programme of Welfare Reform which is fit for purpose, and which really meets the needs of some of the most vulnerable people in society.  The present arrangements should be rejected because they are dangerous, punitive and would be completely unacceptable to most of the population if their true impact was exposed.  Philip Gould, one of the architects of New Labour, advised Tony Blair in 1997 to ‘Reassure, reassure, reassure’.  Ed Miliband explicitly needs to ‘Reassure, reassure, reassure’ the population of the UK, that they will be appropriately protected and helped if they or their family are, or should find themselves, vulnerable and in need due to long-term illness or disability.

(1) http://think-left.org/2011/08/04/welfare-reform-and-mecfs/
http://think-left.org/2011/11/19/doctor-doctor-2/ 

Source

New evidence of UNUM's influence on welfare reform

New evidence suggests that an insurance giant that could make huge financial gains from government reform of incapacity benefit played a much larger part in influencing those reforms than it previously admitted.

Last month, Unum, the UK’s largest provider of “income protection insurance” (IPI), denied that it had attempted to influence government policy on welfare reform.

Campaigners believe that tougher welfare rules – particularly those replacing incapacity benefit (IB) with the new employment and support allowance (ESA) – could persuade more people to take out IPI, and so boost Unum’s profits.

Unum has denied that it stands to gain from the reforms, even though it launched a major media campaign this year just as the coalition government began a three-year programme to reassess about 1.5 million existing IB claimants through a new, stricter test, the work capability assessment (WCA).

But now a detailed memo has emerged, which was submitted to the Commons work and pensions committee in 2002 and was written by Joanne Hindle, Unum’s corporate services director.

In the memo, Unum calls for fundamental reform of the welfare system, while it says the government “must ensure both that work always pays more than benefits, and more importantly that it is clearly seen to do so”.
The memo includes proposals with a strong resemblance to reforms introduced several years later by the Labour government, when it replaced IB with ESA.

The Unum memo suggests retaining a form of IB for those “genuinely incapable of undertaking any work whatsoever”, as Labour did with the ESA support group.

And it suggests a new benefit for those with “limited capacity to work”, who would be “properly supported in their search for and transition into work”, a suggestion which mirrors the ESA work-related activity group introduced by Labour.

The memo also says Unum was “actively engaged” with the government on sharing best practice on returning disabled people to work, while its executives had “met with [government] officials to help better understand the nature of the IB casebook, and to discuss how our commercial experience and expertise might be more widely applied”.

Hindle stresses in her memo that the company – then known as UnumProvident – “is confident that its policies and approach to [IPI] claim management and rehabilitation can be replicated more widely for those on IB” and would “particularly welcome the opportunity to put them into practice”.

The subsequent reform of IB was hugely controversial, with widespread anger among disabled people at the severity and inflexibility of the WCA, and the number of claimants subsequently found “fit for work”.

The anger has grown over the last 18 months under the Conservative-led government, with claims that its reforms – which are even harsher than those introduced by Labour – are merely a cover for cuts to welfare spending and are plunging tens of thousands of disabled people further into poverty and distress.

The disabled activist who has done most to raise concerns about Unum’s influence is Mo Stewart, a retired healthcare professional and veteran of the Women’s Royal Air Force, who has been researching Unum for nearly a year.

She said it was “incomprehensible that Unum have denied benefiting from the ongoing radical welfare reforms when the wording of some of the reforms closely mirror” comments in the memo submitted by the company.

She said: “The recent mass marketing of Unum IPI, combined with the excessive publicity about the ongoing destructive welfare reforms, is no doubt reminding the able-bodied ‘squeezed middle’ population to be prepared in case of unexpected serious health or disability difficulties which, inevitably, will lead many to invest in IPI from this American corporate giant.”

Further information has emerged this week suggesting that Unum had influence within the Department for Work and Pensions as the government was drawing up its proposals for IB reform.

Last month, Unum admitted that two of its executives – a doctor and an occupational therapist – were involved in “technical working groups” set up by the government in 2006.

The working groups were asked to review the assessment that was being used at the time to test disabled people’s eligibility for IB.

Unum told Disability News Service (DNS) that the working groups met just once and that the company had “no further influence” on the design of the test’s eventual replacement, the WCA.

But a response by the Department for Work and Pensions to a Freedom of Information Act request from DNS suggests that the Unum officials were present at three meetings of one working group and at least five of the other.

This week, Unum repeated its denial that it had influenced the welfare reforms of the Labour and coalition governments.

John Letizia, Unum’s head of public affairs, said in a statement: “While Unum, like the vast majority of Britons, believes a review of the current welfare system is necessary, we are not working to influence the government to reduce welfare benefits as you seem to be suggesting.

“Rather, given our expertise in income protection and vocational rehabilitation, we have been one of a number of entities from industry, trade unions and health invited from time to time to participate on committees and provide input to government.

“Our primary interest is in promoting the role the private sector can usefully play not only in helping people to protect themselves should illness or injury occur, but also to achieve a successful return to work where possible.

“Income protection does not replace state benefit, but it is a vital protection for the ‘squeezed middle’ who would not be able to maintain their current lifestyle should something unexpected occur. This would also provide significant direct and indirect benefit to the state.

“At no time have we influenced the government on the design of the reforms to the welfare state or on the level of benefits that claimants receive.

“Additionally, as you know, it is ultimately the government and not Unum or any other third party that makes decisions about policy matters.”

He added: “Whilst we are always willing to answer questions… please understand that we do not intend to continue to discuss events from 10 years ago or engage in a back-and-forth that is based on a false premise, particularly if your mind is made up as it appears to be.”

Source

Is Labour abolishing illness? [From 2008]

By Alison Ravetz Published 01 May 2008

Incapacity benefit has become one of this year's favourite scare stories. Hardly a day passes without a new headline deploring its soaring costs and the rising numbers of claimants who get "something for nothing", at the expense of decent, hardworking taxpayers. We are told that we are footing an outrageously escalating bill for 2.4 million people, a million of whom shouldn't be on the benefit at all, and each successive work and pensions minister vows to be more ruthless than the last.

The true picture is somewhat different. The unreported version, which can be culled from Department for Work and Pensions (DWP) data, is that only 1.4 of the 2.4 million actually receive any payment, the rest get national insurance credits only, and numbers have been falling since 2003. The basic benefit is worth barely £3,000 a year. After two small rises in the first year there is no further increase, other than index-linking. All those who get the benefit have to pass a rigorous "personal capability assessment" (PCA) with doctors appointed by the DWP; and they can be re-examined at any time. The audited estimate of fraud is under 1 per cent - the lowest of any part of the social security system.

Nonetheless, the 2007 Welfare Reform Act is now being implemented across the country. It replaces support, as of right, for illness/disability (one of the planks of our rapidly disappearing welfare state) with a new, conditional employment and support allowance. Claimants are held on a basic allowance until it is confirmed that their capability for work is limited. This is determined by a "work capability assessment" tougher than the old PCA. Those deemed capable of one day returning to work (and the arbiters are health professionals rather than doctors) must engage in a series of "work-focused" interviews and activities. These include, among other things, "condition management", which in practice is likely to consist of group sessions loosely based on cognitive behavioural therapy. All this brings an additional slice of benefit that can, however, be cut for those who do not engage in it without "good cause" - a potential loss of 40 per cent of income. Ultimately, any whose capability for work remains limited through failing to follow medical advice, or "any prescribed rules of behaviour", face a period of disqualification. (A further provision of the act, to be piloted in nine areas, is that people served with Asbos - antisocial behaviour orders - can face cuts in their housing benefit for refusing local authority offers "to help address any problem behaviour".)

A main selling point of the reform was the great savings it would bring. It would staunch the outflow of benefits and get many people into jobs where they would pay tax and provide for their old age. This government's cherished goal is an employment rate of 80 per cent of the working-age population - though it is difficult to find any reasoned argument in support of this since our present rate of 75 per cent is, with Canada's, the highest in the world. The government accepts that employers must be paid to take on people with an illness record and, for the time being, it has pledged not to cut the benefits of existing claimants. Any immediate savings, therefore, can only come from bumping as many as possible off the benefit, shaving future benefit levels (already well in hand), and making it harder for newcomers to get it in the first place. Delivery is being farmed out to private agencies paid by results - which means, of course, the setting of targets. The next few years will be a bad time to have a crippling accident or succumb to a serious disease, particularly a psychiatric or neurological one that does not have obvious outward symptoms.

Blaming the "cheats"

The reform of incapacity benefit has been over ten years in the making, leaving in its wake a dense trail of commissioned reports. A curious thing about this voluminous material is how little information it contains on the actual health conditions for which benefit is paid. This is no accident, for the reformers long ago made up their minds that claimant numbers are too high, therefore a large proportion - usually put between a third and a half, but lately upped to 70 per cent in some quarters - must be spurious. An appeal to history is repeated like a mantra that, back in 1979, only 700,000 claimed the old sickness/invalidity benefits. Since then, money has been poured into the NHS while health care, living standards and longevity have improved beyond all expectations. People must be healthier, which proves that huge numbers are exploiting a slack and obsolete system. Who is to blame, apart from outright cheats? It can only be the self-indulgent, who fancy themselves sicker than they really are, and complacent GPs who let them think they are too ill to work.

Crucially, the reformers bracketed illness with disability. The disability lobby had long argued that "disability" was a discriminatory label imposed by society, and it was bent on removing the barriers to work that excluded those so labelled and kept them in poverty. But the bracketing brought confusions - for those with disabilities may be extremely fit (consider the disabled athlete), whereas the able-bodied can be extremely ill. More confusion arises with conditions such as "stress", "anxiety" and "chronic fatigue" that sound trivial. As for "back pain", how unreasonable is it to take time off sick for something best dealt with by a stiff upper lip and the odd aspirin? It is easy for those in good health to pooh-pooh such things, agreeing with the government that "Work is the best therapy".

The government's declared mission is to "liberate" claimants, to bring them into its "reformed, coherent welfare state for the 21st century". It seeks to overturn a culture based on the "medical model" of illness that allows them to "drift" on to long-term benefits without realising that "symptoms, feeling unwell, sickness and incapacity are not the same" - hence the appeal of cognitive behavioural therapy, which it understands as a treatment that will talk the sick into believing they can lead normal lives.

Doctors - so often the refuge of desperate people trying to find out what is wrong with them - should as far as possible be excluded from the process. Even those working for the DWP have opinions that are "unfounded, of limited value and counter-productive", while GPs are "unaware of the importance of work, the absence of which leads to depression, poor health, higher rates of suicide and mortality, poverty, and social exclusion". (The quotations are from a 2005 study from the Unum Provident Centre for Psychosocial and Disability Research at Cardiff University, whose ideas and rhetoric infuse the reform. Unum Provident is an American firm, the largest disability insurance company in the world, which is currently in litigation in different countries for refusing to pay out on some of its policies.) A private agency has now taken over the running of its first GP surgery here, and doctors dealing with disability living allowance are advised not to invite patients to explain how their condition affects them.

Features of the reform are familiar from other policy areas. First, a demonisation of a needy or vulnerable group, followed by a rebranding: so claimants become not even "clients" but "customers" (as in the just published "Commissioning Strategy" document); incapacity benefit becomes employment and support allowance; sick notes are redrafted for doctors to certify, not what patients can't but what they can do. Next come "partnerships", on an unchallenged assumption that the public sector has failed. The new system is farmed out to for-profit or non-profit-making agencies paid by results. This entails targets, and where targets are set, sanctions follow, for any who "fail to recover".

There are features of the new programme that look intelligent and humane, doubtless owing much to the efforts of the disability lobby. They include a longer and more flexible bridging period (and a back-to-work grant) between benefits and work, and a broader view of "work- focused" activities. The crunch will come with those described as not able or prepared to engage "because [of] the nature and severity of their health condition, or more a matter of attitudes, perceptions and expectations which may or may not be accurate . . . It is a question of what the claimant cannot do vs what they will not do."

For the reform stakes everything on a gamble: that a large proportion of claimants, present and to come, are fit enough to work. There seems no way of proving or disproving this, other than trying it out, at the risk of much waste of public money, and much personal grief. Deliberate rejection of the "medical model" deprives us of all we might have learned (from the wealth of data available) of the impact of illness on our society.

I have scratched my head long and hard over this reform (among other things sending out lengthy submissions to all concerned during the long consultation phase in 2005-2006) because so much in its theory and rhetoric contradicts my own experience: of chronically and seriously ill family members and friends, of several years as a Mind volunteer, and further years of peripheral involvement in action groups for chronic fatigue conditions. All this has indelibly impressed me with the courage of many who live with horrible complaints, the sheer hard work involved in their day-to-day coping, their relentless search for any amelioration, let alone cure, often at costs hard to spare from limited resources.

I have witnessed, too, and at close quarters, the hurt and stress of living difficult lives as people have to do, in a perpetual culture of disbelief and threat, where some of the most valiant are blamed for their conditions and conflated with the alleged "can't work, won't work" unemployed. For the message of the reform that comes across, for all its fashionable rhetoric, is that a person is valued only as a productive unit. Compassionate cases aside, those too ill to work are outside society and money spent on them is wasted. Sickness, disablement and inability to work have no place in a modern society - they can't and shouldn't be afforded.

No one pretends that illness is not a blight, imposing personal and social costs going far beyond the financial; but - pace the government - no one as yet knows how to remove it from the human condition. Why waste valuable time and resources on an ill-founded reform, when they could instead be used to further understanding of the real impact of illness on our society?

Alison Ravetz is a professor emeritus of Leeds Metropolitan University who writes on housing policy and welfare reform

New Statesman