Your opinions of co-location of IAPT staff in Jobcentres

[Contrarian]

Hi I live in Lewisham and work in mental health services. I was shown some posts on Sunday on the Brixton forum on the topic of co-location of IAPT staff in Jobcentres and put the pros and cons voiced in this forum together. If anyone has any other thoughts on it to add I would love to get a discussion going on the issue. It's not within my power particularly to do much on my own, but I have friends who work in IAPT who aren't too happy with what's happening and it would be really useful for them to read what the local community thinks and to have the issue highlighted. I've posted it here as I'm hoping to spark a discussion beyond the Brixton forum because the issue is relevant as this may be rolled out across the UK.

Been informed there is a mass protest happening against:
Lambeth Community Mental Health Services moving to Streatham Job Centre, and the establishment of the UK's first psychological therapies department at Streatham Job Centre - explicitly merging mental health services with the DWP's agenda of harassment posing as "Back to Work."
For more details: Here is the Facebook Page - https://www.facebook.com/events/1632671646970164/

From http://base-uk.org/members/news/budget- ... -announced
More support for people with mental health conditions
These were announced in the March budget statement and include early access to supported Online Cognitive Behavioural Therapy and the co-location of IAPT (Increased Access to Psychological Therapy) staff in Jobcentres. This will begin with Streatham Jobcentre Plus. For more information on these and other measures announced, go to Budget 2015 on gov.uk.

Pros
- Mental health problems and poverty are linked and can be targeted together: Lambeth is one of the poorest boroughs and has one of the highest incidence of mental health issues. Reaching out to and supporting people with mental health problems will help them back into work and this will improve recovery rates.

- Any spending on mental health is positive: When reorganised in 2010, Mental Health Services in Lambeth had an immediate 50% funding cut with an extra 5% cut each year for the next 5 years with the emphasis on spending on IAPT. SLaM pre-2012 had 4 floors of a wing in St Thomas' Hospital an by mid-2012 it was half the basement of the same wing. Any spending on mental health in the borough is welcome.

Cons
- Job centres often now have many security staff. People with mental health problems may be put off from engaging and/or claiming benefits by the atmosphere generated by this.
"To anyone more paranoid than me going for CBT or any other treatment in Brixton Job Centre would be not much different from going to Brixton Police Station."

- This has been instated without community consultation which often has applied to issues surrounding planning, regeneration, libraries, local environmental improvements.
"Why can't we be consulted about our views on mental health services?"

- There is a potential conflict of interest for DWP to fund CBT practitioners in job centres: it will impact on confidentality with information likely to be shared with other government departments that may not have clients best interests at heart.

- A pre-requisite for psychotherapy and building a therapeutic alliance is that clients feel they than talk openly in an environment that is not judgemental or based on a goal set from outside (aligned with interests of DWP).
"I would not want to go to the job centre. The staff at the job centres treat you like you have done something wrong, they are useless when it comes to helping you find work and are just there to process you through their systems. Crossing mental health services with the job centre seems to be more about getting more people back to work than helping the recovery of those with mental health issues."

- CBT is a form of therapy which locates problems in the individual rather than systemically. In a context of Austerity measures and zero-hour job contracts, does this lead to a re-framing of ideas around the self and responsibility around stoically (passively?) responding to what may be very unjust social and working practices?
"Do politicians really care about mental health anyway?
CBT is ideal therapy from a politicians point of view:
1. It can easily be time limited (12 weekly sessions or some such)
2. It is measurable - as the treatment involves repeated filling in of a Beck Inventory or variant.
3. It is in effect a form of brain-washing designed to change a negative attitude into a positive one.
Obvious fit for a Job Centre I would have thought."

- Is CBT in job centres going to be offered solely to people on benefits or will it also be provided to people not claiming benefits? Ian Duncan Smith has talked a lot about helping to get people off benefit by cutting it off. It is unknown whether CBT will therefore be an exercise in acting coercively towards people identified with having mental health problems but unwilling to engage in CBT (e.g. avoiding completing homework). Also, it is unsure whether improvements in outcomes may be conflated with being healthy enough to engage in work (with the possible threat of having benefits cut off). This threat of coercive influence appears to go against the BPS code of ethics.
"I would have thought that doing therapy in the Job Centre would be very threatening to people on benefit, but otherwise not so much. But I very much doubt they would be offering therapy to non-claimants in the job centres."

- St Thomas' Hospital is one of the few places alternatives to CBT is offered (e.g. CAT and other forms of psychotherapy). Provision of this is decided during the initial discussion one has with one of the therapists there. This appears more ethically sound as it takes clients' opinions into consideration & offers choice vs solely offering CBT with its encroachment into Job Centres.

 

[CH1]

Not sure what you want to do with this thread. This my contribution.

I am now over 60 and it seems I am unlikely to be seen by an adviser again because of age (unless IDS cracks the whip again).

Previously I was seen sometimes by a DEA, but my main battle was between myself and ATOS - who initially completely repudiated my diagnosis, then when I appealed and won seemed to be OK with contacting my GP.

The previous government time limited ESA to one year, so I got my benefit cut off for 2½ years. Now it has been restored - apparently because I am over 60.

Confused - I certainly am, not least because I have never been given benefit advice (not being a tenant, I guess I am not supposed to need it)

As for Improving Access to Psychological Therapies I am not sure why I would be offered this as I am not required to see an employment adviser. I have mood stabilising medication (Lithium) prescribed by GP, as it has been for the last 13 years.

I have had a one year course of CBT about 2002 - as an experimental project of the Institute of Psychiatry designed to check the effect of CBT for patients on various medications and none. I found this quite interesting and helpful.

More recently in 2013 I was put on a group CBT/Mindfulness course of three or four sessions. I found this very unhelpful as all of the group seems cheerful and ebulient, if not actually manic, whereas I was seriously depressed, and it made me feel much worse.

As for IAPT in Job Centres - to me it seems there is a serious danger it will be used to force people into unsuitable work. The line being - this is your therapy and support - now get a job and do it like any normal person would.

 

[Plumdaff]

It's a terrible, dangerous idea. There's a demonstration on the 26 th June about this. I'd post more eloquently but I'm knackered.

 

[equationgirl]

Not sure why you've started this thread or what you will do with the information, however I personally think it's a terrible idea to colocate these services as it will not help people and is more likely to deter people because of concerns over confidentiality.

 

[superfly101]

Well you've collated a lot of peoples views from the Brixton thread and added a few comments which is a bit meh tbf!

How about your own views on mental health provision currently, historically and the vision for the future?

Say maybe;
The adoption of low level CBT - that nice TV GP Rosemary Conley stated CBT might help 40% of people on the CH5 program the Wright Stuff last month

 

[superfly101]

Continued as I pressed tab or out

How are the therapy success outcomes from CBT are measured?

Why is CTB revolving door? - You have your 6 sessions are discharged then even if it's 30 seconds later you're referred back you're treated as a new patient - why are patient treatment histories a taboo subject and rejected by IAPT?

Provision across boroughs e.g Lambeth has CBT or Wellbeing, Southwick has CBT and Relaxation therapy since it all use to be SLaM why can't somebody who needs relaxation therapy in Lambeth get it and vice versa.

How do you feel about your new and improved career progression prospects? When the best you can hope for and only positions open in the NHS are for low level CBT practitioners? Are you a bit tetchy about them pulling all other therapy disciplines which you could have entered? Do you feel demoralised, betrayed and stuck?

I could go on but will end here.

The question I asked "Was why is this an issue?"

Why would placing IAPT in a job centre be bad? We already have them once a week in the local libraries and other community places so......

I accept job centres are oozing despair and quite frankly depressing places to be. I'm not sure if any of you visited the IPTT teams building by Streathem Station ffs it made Brixton Job Centre look like Buckingham Palace. Even the naughty part with the ceiling to floor screnes down the ally way (left left again) was like the Ritz.

 

[Blagsta]

It's a really bad idea.

 

[Red Cat]

It's a terrible, dangerous idea. There's a demonstration on the 26 th June about this. I'd post more eloquently but I'm knackered.

Do you have a link?

Ignore, just seen link in op.

 

[superfly101]

It's a really bad idea.

I agree fully as I have previously said but......

Somebody posts a facebook page saying this is bad we're demonstrating.

I've asked the question why because it doesn't tell me?

You can't just say it's bad because... you have to have reasons - preferably explaining those reasons with a some sort of rational?

So far except for it's the Job Centre so... a few loose we don't understand the DPA arguments about privacy... which at this time might be very applicable but easily stopped... tell me why it's bad!

 

[SpookyFrank]

IME the jobcentre is a contributing factor to deteriorating mental health for a lot of people, especially when they've been kicked off ESA. Forcing people to go there for mental health treatment seems a pretty macabre thing to do in the circumstances.

 

[StoneRoad]

I agree, this co-location is a bad idea.
On the grounds that being unemployed is bad enough even for someone w/o MH issues and secondly confidentiality issues. The latter is one reason why CABs located in public facilities like libraries are supposed to have a separate access route.

 

[superfly101]

IME the jobcentre is a contributing factor to deteriorating mental health for a lot of people, especially when they've been kicked off ESA. Forcing people to go there for mental health treatment seems a pretty macabre thing to do in the circumstances.

I'd never seen security staff until I came to London. Nor had I experienced the superior attitude and bullying (Harry Enfield I'm better than you!) that was/is rife in London job centres.

They are not forcing they can not force. It's is written into the DWP legislation that benefit can not be awarded on the condition of up take of any sort of medical treatment.

I agree, this co-location is a bad idea.
On the grounds that being unemployed is bad enough even for someone w/o MH issues and secondly confidentiality issues. The latter is one reason why CABs located in public facilities like libraries are supposed to have a separate access route.

I think this is very valid and could lead to the targeting, bullying and the following home of vulnerable people to exploit them.

 

[ViolentPanda]

It's a terrible, dangerous idea. There's a demonstration on the 26 th June about this. I'd post more eloquently but I'm knackered.

Lambeth Community Mental Health Services did me a solid back in the mid-'90s, where they had their "north" and "south" community sites (I attended the southern site at Lewin Rd, Streatham Common). Even back then they were keen to increase access to psychological therapies, but under supervision from a "panel" of psychiatrists and psychologists, and in an environment free from outside pressures, not in a fucking job centre where the stink of stress permeates everything.

 

[Plumdaff]

It's really important that psychological interventions, regardless of what type, are freely entered into and the focus and change is decided by that person. I have fears of people being mandated into attendance by the Job Centre and the desired outcome of any "therapy" (basically, get a job) being dictated by them, even if the health care side wasn't fully aware. Of course it will be that person's fault if the therapy doesn't 'work' missing the point about what therapy is actually about.

They're my fears, and I'm coming from the health professional side of things. God knows how terrified I'd be as a claimant.

 

[SpookyFrank]

They are not forcing they can not force. It's is written into the DWP legislation that benefit can not be awarded on the condition of up take of any sort of medical treatment.

That's like saying nobody is 'forced' onto workfare because they're welcome to starve to death instead. If people need treatment and the jobcentre is the only place they can get it, then there's no real choice there at all.

 

[Plumdaff]

They are not forcing they can not force. It's is written into the DWP legislation that benefit can not be awarded on the condition of up take of any sort of medical treatment.

That can be got round. It's not a medical treatment it's a psychoeducation group!

And how soon will IAPT funding be linked explicitly to "back to work" targets?

 

[smokedout]

The question I asked "Was why is this an issue?"

Why would placing IAPT in a job centre be bad? We already have them once a week in the local libraries and other community places so......

The government has already announced plans for some kind of Jobcentre mandated treatment, and has just consulted on new information sharing powers between Jobcentres and service providers. The culture of Jobcentres is punitive, and the aim is to force people into low paid work, or off benefits completely via sanctions. This is incompatible with healthcare, it assumes that work is good for you, when it often isn't, and it uses extreme poverty as a coercion tool. Even if attending IAPT is not mandatory, and eventually it probably will be, the level of coercement in Jobcentre, combined with targets for Jobcentre staff to refer people to new provision, often means that things are presented as mandatory, or that less confident claimants are too scared to refuse to attend. The end result of this will be to demolish the relationship between mental health support services and users, create a culture of mistrust and further entrench the position that unemployment is caused by unemployed people who need to be fixed, often by forcing them to work without pay. Mental health services will no longer be about helping people get better, but policing their attitudes and attempting to create personality changes with the kind of howdy diddly fucking doody crap that is already becoming prevalent throughout Jobcentres. It is healthcare, and psychiatric services being weaponised against the poor. So yes, it's bad.

 

[Libertad]

The Void has written an excellent piece on this:

Iain Duncan Smith’s First Re-Education Centre To Open In Streatham Jobcentre

https://johnnyvoid.wordpress.com/20...cation-centre-to-open-in-streatham-jobcentre/

 

[Plumdaff]

Also as someone who uses CBT both personally and with people I work with, I'm so pissed off that a/it's being wrongly pushed as some kind of universal panacea b/ some of the principles of CBT being used in a really twisted way to somehow locate the problem of unemployment as an individual failing or problem. As if CBT can or should be all about getting someone a job It should be about individual values and goals and if a by product of lessening suffering someone wants to return to work then great, but that's not what it's about.

It's fucking disgusting and health professionals should be refusing to work in such an unethical way. I'm kind of appalled but not shocked about this, there was always an element of this in the government's mind even when IAPT was being piloted. Have some access to therapy, but there's a sting in the tail.

 

[superfly101]

That's like saying nobody is 'forced' onto workfare because they're welcome to starve to death instead. If people need treatment and the jobcentre is the only place they can get it, then there's no real choice there at all.

Please find me the legislation to back up your point!

You can't because seeking/being in treatment it's explicitly legislated against!

Now there is an issue with "guidance" which the DWP/Council try to use as law but is really their interpretation which is not only has no legal standing but can be against the spirit of the law as laid down.

The old if you were ill you would be in treatment has come via guidance not law .........

 

[CH1]

So what are people's view on the Clubhouse - moved into the old Effra Day Centre building two or three years ago?

Operate on self-referral. They are explicitly there to assist people with mental health problems, but do not require a diagnosis.

They are very clearly oriented towards work. People just sitting about will be asked to undertake tasks or join a work team (office, catering, gardening etc) They bring in benefits advisers etc for users problems, like a surgery.

They will try to get users into work in outside organisations, by gentle stages if necessary. Or if they can't handle work outside they will provide tasks in-house, and a subsided canteen.

Nothing to do with DWP - it is jointly funded by LB Lambeth and SLAM.

Be interesting to see their statistics - how many people pass through, how many get jobs, drop out or just stay around.

 

[crossthebreeze]

Please find me the legislation to back up your point!

You can't because seeking/being in treatment it's explicitly legislated against!

Now there is an issue with "guidance" which the DWP/Council try to use as law but is really their interpretation which is not only has no legal standing but can be against the spirit of the law as laid down.

The old if you were ill you would be in treatment has come via guidance not law .........

But what difference does it make if it is guidance or law if you are a vulnerable claimant with no access to legal recourse (due to the legal aid cuts)?
Anyway, from the 2015 tory manifesto "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."
They are seriously looking at changing the law on this.

Also jobcentres have security guards in many parts of the country, and bullying and superior attitudes are found in most jobcentres.

 

[SpookyFrank]

Please find me the legislation to back up your point!

You can't because seeking/being in treatment it's explicitly legislated against!

The DWP does what it can get away with, not just what's legal. All the really bad stuff is in internal policy, not legislation. And even when they're found to have broken the law, the law can be changed retrospectively to let them off the hook.

The DWP is also happy to deny overwhelming evidence of misconduct, safe in the knowledge that they will never be properly investigated or held to account. People cannot trust the DWP, they know that from their own experiences. Therapy needs to happen in a safe, trusted space and the jobcentre is pretty much the opposite of that.

 

[superfly101]

So what are people's view on the Clubhouse - moved into the old Effra Day Centre building two or three years ago?

Operate on self-referral. They are explicitly there to assist people with mental health problems, but do not require a diagnosis.

They are very clearly oriented towards work. People just sitting about will be asked to undertake tasks or join a work team (office, catering, gardening etc) They bring in benefits advisers etc for users problems, like a surgery.

They will try to get users into work in outside organisations, by gentle stages if necessary. Or if they can't handle work outside they will provide tasks in-house, and a subsided canteen.

Nothing to do with DWP - it is jointly funded by LB Lambeth and SLAM.

Be interesting to see their statistics - how many people pass through, how many get jobs, drop out or just stay around.

Feb edition of Lambeth Living (online too) has this but the WW of "Clubhouse" only lists Islington?

It actually looks very good but...

 

[equationgirl]

Contrarian have you enough information yet, to take this forward? What are your plans?

 

[J Ed]

https://theconversation.com/facing-...ecome-a-daily-part-of-claiming-benefits-42839

Curing unemployment is a growth market for psychologists. Job Centres are becoming medical centres, claimants are becoming patients, and unemployment is being redefined as a psychological disorder.

Made-up ailments such as “psychological resistance to work” and “entrenched worklessness” feature in ministerial speeches and lucrative Department for Work and Pensions (DWP) contracts, without attracting a murmur of protest from professional psychologists.

Psychological explanations for unemployment – the failings of the maladjusted jobseeker – isolate, blame, and stigmatise unemployed people. They reinforce myths about “cultures of worklessness”; they obscure the realities of the UK labour market and the political choices that underpin it. The same is true of psychological prescriptions for treating unemployment.

Interventions

People claiming benefits are already subject to psycho-interventions through mandatory courses designed to promote “employability” and “job readiness”. And as we show in a new paper published in Medical Humanities, “positive psychology” is pervasive in Job Centres (the newly privatised Behavioural Insights Team has trained more than 20,000 Job Centre staff. A narrow set of approved psychological and personality traits are widely touted as essential to getting and keeping a job: confidence, optimism, positive, aspirational, motivated, and infinitely flexible.

Motivational “messaging” targets both staff and claimants, and is set to intensify. The 2015 budget sets out government plans to put therapists in job centres this summer. Online cognitive behavioural therapy will also be provided, in order to “improve employment outcomes” for claimants with mental health conditions. (Some of the many problems with these approaches have recently been discussed in The Conversation.)

The “change your attitude” message of positive psychology is enforced by unsolicited “positive thinking” emails sent to claimants, and in mandatory “employability” training courses promising to help with “self-esteem, self-confidence and motivation".

...

In the past, conditionality related to things like refusing to take a job after receiving three offers of work. This was hardly beyond criticism. Now, the supposed absence of positive affect can trigger some form of sanction. “Lack of work experience or motivation” is one of the criteria for being sent on a Community Work Placement – six months’ unpaid community service for 30 hours a week.

People are unemployed because they have mental health issues, not because of the labour market, if they protest and argue that the labour market is the reason they are unemployed then that is evidence of them being a suppressive person therefore they must be subject to forced labour or they are just outright sanctioned. This country is terrifying.

 

[CH1]

Feb edition of Lambeth Living (online too) has this but the WW of "Clubhouse" only lists Islington?
It actually looks very good but...

It's on Clubhouse International under "M": http://www.iccd.org/clubhouseDirectory.php?fl=M

Funnily enough my employment adviser considers them "a cult". Obviously that is a personal view, and I suppose in actual fact even cults can help people feel better integrated/adjusted. Whatever Mosiac Clubhouse may be, it is not financially exploitative.

 

[CH1]

I was at a user panel meeting today regarding surveys/questionaires used in measuring depression/anxiety - partly connected with My Health Locker - SLAM's health record system designed to assist with monitoring mood states and also blood pressure & weight over time, hopefully to trigger appropriate interventions in case of adverse changes.

I have participated in this for 2 years and my experience is that it could be useful - but it is completely hopeless trying to get your GP integrated into the system. Total bank wall. My psychiatrist will discuss the data - but only if served up on a plate, so to speak. Weird isn't it - SLAM developing a computer management system for mental health condition, and their own psychiatrists not really interested, and GPs - who ultimately have to pay the bill through the CCG are actively hostile.

If this is indicative of the degree of integration between DWP and the therapy project, I doubt they could get it together to do any coercion.

That is not to say that Job Centres are appropriate venues for therapy. Actually it is difficult to think of venues with small offices for one on one consultations. Maybe that one driver for the Job Centre idea.

 

[mauvais]

So what are people's view on the Clubhouse - moved into the old Effra Day Centre building two or three years ago?

Operate on self-referral. They are explicitly there to assist people with mental health problems, but do not require a diagnosis.

Many NHS IAPT services are self-referral, without requiring a GP to act as service gatekeeper.

Aside from the dubious conflict of interest that's probably inherent to this co-location, the problem that strikes me is that CBT is meant to be a proactive patient-led course that you opt in to, and not a treatment that you are just frogmarched into, because if they're not your own goals that you're genuinely pursuing, or at least if the process of it doesn't assemble you into that form very quickly, then what's the point.

CBT no doubt has merit to a fair chunk of those in unemployment; potentially anyone who at the highest level actively wants to return to work, but is blocked by some MH issue, e.g. PTSD, anxiety etc. It's also in theory entirely possible that the Job Centre is an appropriate venue for that service, if it were structured properly.

However you have every right to be suspicious of the DWP and if this is anything other than an optional, offered hand, then it seems quite right to protest it IMO.

 

[mauvais]

Also I asked my other half, a CBT therapist, for an opinion, and she paints a bleak picture for her profession; it's going to reflect the hatred of the DWP on to IAPT, and therapists will now be seen as the enablers of inappropriate fit-to-work decisions, even if this is not actually the case. That's going to be toxic and have a very broad impact, IMO potentially ending up with a public image something like that of social workers.