Communication, or lack of communication

Last October the government decided to make 2011, The Year of Communication, the name of the project is Hello, and mainly targets children and young people, there is very little for adults. Considering that there are over Twelve Million adults with literacy and communication problems in the United Kingdom (National Literacy Trust, 2008), the remit of Hello is far too narrow, and I think the government were very short sighted when setting the parameters for this project.

I work as a volunteer mental health advocate and my job is to help empower people who have mental health issues to self-advocate, and to help them have their voice heard where they have previously been ignored. Many of my advocacy partners, (a client is known as an Advocacy Partner (AP) because we work together to resolve their issues), feel ignored by public officials, doctors, psychiatrists and a whole host of other individuals and authorities, whose rulings and diagnoses have a very real effect on their lives.

Recently someone said to me “I wouldn’t have thought that a person with mental health issues had the aptitude for logical or rational thought”., This comment highlights the stereotypical image which a very large number of the population have of those of us with mental health issues and our ability to communicate. It is both an acquired and inherent form of discrimination, so ingrained that it comes as second nature to those who are guilty of it. Unfortunately, this attitude is encountered in every part of the benefits, tax and health systems where far too many have forgotten how, are unable, are in too much of a hurry, or are too impatient to listen. If no one listens to what is being said, then there is no communication.

The majority of benefit claim forms (ESA, DLA etc.) pay very little regard to the fact that a person can be disabled by a mental illness, instead they concentrate on physical disability. Of course, physical disability should be taken into account but the benefit agencies must make sure that every disability whether caused by a physical or mental illness is regarded as being equally severe, if they do not, then they are plainly guilty of discrimination against those with a mental illness. When filling in the forms APs see the scant attention paid to mental illness and begin to feel depressed and ignored before the Decision Maker - a title that conjures up images of the Fat Controller from Thomas the Tank Engine - reaches a decision. It is time that those who write the explanatory notes and leaflets, which accompany claim forms, just as those who set the questions on these forms, were both made to consider carefully what messages they are sending to the claimant with their notes, leaflets and questions, aswell as the effect those messages, and the manner in which they are written, might have on the claimant.

After the forms come the medical examinations bringing yet more stress and anxiety. Medical examinations such as the Work Capability Assessment (WCA) are more like interrogations during which the claimant is subject to rapid-fire repetitive questions. As an advocate, I have attended WCAs with some of my APs, and on occasions have had to ask for a break to enable the AP to regain their composure. There are questions such as ‘How long can you sit before it becomes uncomfortable and you have to move?’ followed later by ‘Do you enjoy watching films on television?’  If the claimant says ‘Yes I enjoy watching films, but have to record them, so that I can take a break, because I can only concentrate for a short time’, or ‘Yes, but I have to stand up to watch television’. They are told ‘I only need to know if you enjoy watching films.’  Perhaps it is the cynic in me, but the question about films appears to be another way of finding how long a claimant can sit. The problem is that the question is based on the premise that everyone watches an entire film in one session and that everyone sits down to watch television. This is just one example of a claimant not being allowed to communicate with their examiner or put another way, of not being listened to by the examiner. It would appear that unless an answer fits the relevant ‘box’ on the list of questions, used by the ‘Atos’  examiners (the company that the DWP use to carry out their medical examinations), then the answer is unacceptable.

Until all those who have direct, or indirect contact with claimants are given Mental Health First Aid training with a compulsory refresher each year, and the claim forms are radically revised to make them inclusive of mental health issues and mental illness, the current obstacles and barriers to those with mental health issues will remain. This will mean that more and more people who may appear to be physically ‘fit for work’ will be forced to try to work, while they remain mentally unfit to do so.