Depression: Should No Treatment Mean No Benefit?

In the news today, there is a worrying story. The government are apparently toying with the idea of telling those people receiving ESA (Employment Support Allowance) for mental health conditions that if they refuse to accept "treatment," their benefit will be stopped.

In theory, this sounds good, right? If you're not prepared to make an effort to go to therapy sessions in order to improve your mental health, why should society help you. Right? Why should we help someone who won't help themselves?

But what if the "treatment" people are being offered is woefully inadequate? What if the only treatment they are being offered is yet another antidepressant, after the three they've tried previously have only made matters worse, and this one has a list of side effects as long as your arm? What then?

Regular readers of this blog will know I had a massive breakdown in 2010. I was lucky enough to be signed off work with full pay for a month, and then took voluntary redundancy with garden leave for my notice period - so my recovery was not fraught with money worries.

But what if it had been? What if I hadn't worked for that particular company, whose sickness policy was very generous for someone who had been there for five years? What if I hadn't had the choice of taking voluntary redundancy? I think I would have had to leave my job; there was no way I could have continued as I was. That would have left me on benefits.

I took the drugs the doctor gave me. I took the Prozac, even when it made me even worse. Even when I stopped eating or sleeping or thinking sensible thoughts. Then I switched and took the Sertraline they gave me, even when I saw no point in it. Even when I was taking as many other pills as I could find in order to get me through the long, dark nights - I still took the bloody Sertraline like a good girl. I did as I was told. But I have refused to take any medication since I fell pregnant with S, and I'm not sure I would be so compliant, were I to get sick again. The Prozac very nearly killed me, and I don't believe the Sertraline did as much for me as taking fish oil capsules has.

I was sent to various "talking therapy" options, including a woefully ill-equipped lady who tried to get me to fill in work sheets for doing the washing up, and group therapy which was largely taken over by a particularly large personality with myriad problems. I went to group therapy for a few weeks, but stopped going when someone from the group saw me in town, and asked me loudly (and in front of mutual friends) whether I felt the group therapy at the mental home was helping me. At one point I was assessed for one-to-one therapy and told I would be put on the waiting list for it, but that it was a long list, the wait indefinite.

I was first referred to the Community Mental Health Team (CMHT) in the Summer of 2010. When the therapy I needed finally became available, it was February 2011, and I was about to start a new job. I turned down the therapy, because I didn't want my first conversation at my new job to be about needing Thursday mornings off to go to therapy for the breakdown from which I am still recovering."

Toward the end of 2011, when I was pregnant with S, I was sent back to CMHT for counselling because the GP was worried about me coming off my medication. The system had changed slightly; now you had to call a number to book an appointment with someone who would be in your surgery one afternoon per week. The idea was that you had your appointment, got some homework, and then booked another appointment for two weeks' time. What actually happened was that you called the number to book an appointment, and got an engaged tone. Eventually after numerous tries, it would ring, at which point you would get a voicemail message saying the person manning the phone was on lunch and you could leave a message. Eventually, after several phone calls, you would be given an appointment in three week's time. After your appointment you would leave and attempt to book another appointment, which might not be for another four weeks because the department was so woefully over-subscribed and under-staffed.

This is the state of mental health care in this country. This is what happens when you don't have the money for private therapy. 

I simply cannot see how the government can even entertain the idea of imposing benefit sanctions on people claiming ESA for mental health issues, if there is no framework in place to cope with them. 

I was very lucky in that my GP had me come back to see her weekly while I was in the throes of my breakdown. She talked to me and made me feel like she actually cared how I was doing. Every Friday, I would go to my appointment with her, get a new sick note and a new prescription, take the sick note to my boss at work, and then go home. Some weeks, those were the only things I was sure to do. It was this routine, and the brief time I was attending group therapy three mornings a week, that gave me some form of routine in my life and allowed me to begin to pull myself out of my pit of despair. By the time my turn came to have the therapy for which I had been so desperate a switch had already flicked in my head and I had realised I had to do this on my own, or not at all; either get better, or get on and kill myself.

If you put a depressed person in the situation where they have to go to these ridiculous sessions or face losing their benefit, you may well find that you leave them nowhere to turn, except the one place all of this is apparently trying to avoid. 

When you are depressed, everything is pointless. There is no merit to doing anything, except perhaps killing yourself. At the very nadir of my depression, I could reel off numerous reasons, not only why I should kill myself, but why I believed people with depression should be able to opt for assisted suicide at a clinic in Zurich. 

If you stop a depressed person's benefit because they can't muster the strength or wherewithall to drag themselves to an ultimately pointless therapy session, what else is left for them? They may as well be dead, a thought that has probably been tormenting them for months or weeks any way.