Over the past 5 years or so, I have frequently had patients with significant mental health problems being deemed fit by the Atos Healthcare administered system of medical examinations for people on sickness benefit. I recently had a patient come to me with heightened distress over this. She felt she was doing well, was seeing a psychologist who was helping her fight her considerable psychological difficulties. Then she received a letter deeming her fit for work, and then an invitation to see a ‘Personal Adviser’ at a Jobcentre Plus office about 2 miles away (she has trouble travelling out of the neighbourhood).
I told my patient (let’s call her H.; this is not her name) about the work of Franz Kafka, about vulnerable people getting caught up in a bureaucratic nightmare. I printed out a few paragraphs from Wikipedia on ‘kafkaesque’. She was comforted by this, knowing that someone had described this situation, that she was not entirely on her own in this.
I told her I would provide her with a letter to take to her interview with the ‘Personal Adviser’ the following week. I asked her permission to write this up on this blog. She consented, provided she remained anonymous. I asked her to write a few words about it felt to be on the receiving end of these letters and injunctions.
Here is my letter to the ‘Personal Adviser':
Sharon(not her name), Jobcentre Plus
I understand that H. is due to meet with you this week.
I think it is important that you be aware that H. suffers from quite significant mental illness in the form of bipolar affective disorder (she was hospitalised two years ago for some time) which at times has psychotic features. She also has chronic depression and anxiety, and panic attacks. She has a sleep disorder, with regular nightmares of abuse she suffered as a child. She is under the care of local psychiatric services, on an ‘Enhanced Care Programme’. She sees her keyworker monthly. She takes antipsychotic medication, mood stabilisers, and antidepressants. She has just finished a course of psychology treatment which she has found very helpful. She also has chronic fatigue syndrome. She struggles to hold things together on a daily basis.
H. has a 22-year-old son with autism. She is his carer. He has high dependency needs.
The DWP seems incapable of assessing people with mental illness intelligently. As a result, a number of patients of mine with significant mental illness are forced to jump through quite inappropriate hoops in order to hang on to their benefits. This system is in itself abusive and worsens their mental health.
I am aware that you are merely doing your job and you have nothing to do with the development of this policy. Please let your superiors know that this lady is struggling to survive and that if you attempt to force her into one of your pigeonholes you risk making her worse.
If you wish to discuss this any further, I can be reached on Tel……
Last night I saw H. again in surgery. She said the Personal Adviser said it was nothing to do with her; she did not make the decisions; she advised H. to appeal; and gave her some documentation and an ‘invitation’ to see someone at A4e, the next hurdle in the thoughtless endurance trek she has to undertake.
She had brought something she had written at my request, about how it felt to be on the receiving end of all this. She said she had difficulty writing it down, so she wrote a poem, she hoped that was ok. She gave me permission to publish her poem, provided she remained anonymous.
Here is the poem: