A Prescription for Clinical Psychology

Recent events suggest that the profession of clinical psychology is adrift, and lacks any ethical or self-critical direction. These events include the failure of the British Psychological Society (BPS) to engage with the perspectives of black people who use mental health services, the emergence of unemployment as a new form of psychological disorder, and the failure of the profession to make a principled response to the use of benefit sanctions by Jobcentre staff against disabled people. The first of these, the failure of the BPS document Understanding Psychosis to engage with the concerns and perspectives of black people with schizophrenia, has already been the subject of critical scrutiny [i] [ii] [iii]. This blog deals specifically with the role played by clinical psychologists in the Jobcentre.

The profession has become embroiled in one of the most controversial aspects of the government’s attempts, as part of the political policy of austerity, to force disabled people and people with mental health problems back to work. There are two aspects to this that raise concern. The first involves what is in effect the redefinition of unemployment as an individual psychological disorder rather than a political or social issue [iv]. This is tantamount to ‘disease-mongering’, something that many leading clinical psychologist rightly condemned the American Psychiatric Association for when it published DSM-5 in 2013.

The second follows from this, and is even more worrying. It concerns the involvement of the profession in assessments and interventions in Jobcentres that are likely to be imposed on benefit claimants under threat of sanctions, a practice dubbed psychocompulsion by Lynne Friedli and Robert Stearn in a recent paper[v]. Shortly after this was published, the BPS responded with an article in The Psychologist [vi] by its then president, who expressed concern “…at what the [Friedly and Stearn] paper has revealed, particularly the issue of coercion to undertake psychological interventions…While psychology certainly has a role to play in the welfare system, it must be used ethically and effectively.” Since then, the BPS appears to have fallen silent on the ethics of psychocompulsion, preferring instead to highlight what it sees as the lack of any scientific basis for the Work Capability Assessment (WCA) in its briefing paper published in November 2016 [vii].

This paper focuses largely on the scientific failings of the WCA, which it sets out in terms of its reliability and validity, together with the absence of an evidence base for the effectiveness of the assessment. It also expresses concern about the way WCA is administered, dwelling at length on the need for properly trained assessors supervised by appropriate clinicians, and the importance of taking into account mental health professionals’ reports about unemployed people with mental health problems. This, it must be said, is an important point.

Beyond that, however, it has nothing to say about the specific ethical concerns raised by Friedli and Stearns and others about psychocomplusion – the use of sanctions to coerce unemployed people to undergo these assessments and interventions with psychologists. The paper makes no reference to the use of coercion in the implementation of the WCA; the word ‘sanctions’ is nowhere to be found in the report; it has nothing to say about how this form of psychological coercion might compromise psychologists’ professional ethical codes.

The BPS is clearly guilty of double standards. In the past it has attacked psychiatry for its role in compulsion, and for creating new categories of mental disorder. It is, however, blind to its own role in austerity, and its complicity with government attempts to coerce benefit claimants through sanctions. This situation cannot be allowed to continue. The analogy with forced psychiatric treatment breaks down because there are at least legal processes and appeals that to some extent safeguard the human rights of people detained under the mental health act. These may be imperfect, but people in Jobcentres and who are coerced into psychological interventions have no such safeguards. Their human right to dignity and choice is trampled over at the whim of DWP staff and psychologists working with them.

If the profession of clinical psychology fails respond adequately to the current situation, psychologists will wake up one morning and discover that they have become agents of the state. The current Chair of the BPS wrote in a recent blog about the value of a marriage between politics and psychological science [viii]. He has also written with pride about the DWP’s interest in computerised CBT [ix]. This foreshadows the next generation of psychological techniques to be forced upon the unemployed through sanctions. This indicates that there is a pressing need for the BPS to review its ethical guidance to clinical psychologists in the light of sanctions. This would be timely in view of the private members’ bill introduced by Maihri Black M.P. for the House of Commons to discuss benefit sanctions.

 

For these reasons we call upon the BPS as a matter of urgency to:

1. Withdraw from future work with the DWP in developing and implementing interventions that will be imposed on claimants through benefit sanctions.

2. Press the government to end forthwith the use of benefit sanctions as a means of coercing claimants into psychological assessments and interventions for Employment Support Allowance

3. Demonstrate professional leadership by setting out clear ethical guidelines for clinical psychologists working in Jobcentres with clients at risk of coercive psychological assessments and interventions.

4. Demonstrate professional leadership by supporting clinical psychologists who refuse to undertake these assessments, or to be involved in coercive psychological interventions with Jobcentre clients.

 

Please sign the petition urging the BPS to review its ethical guidance to psychologists working in Jobcentres.

https://www.change.org/p/peter-kinderman-new-ethical-guidelines-needed-for-clinical-psychologists

Thankyou.


[i][i] http://www.sumanfernando.com/Letter%20to%20Anne%20Cooke.pdf

[ii] Kalathil, J. & Faulkner, A. (2015) Racialisation and knowledge production: A critique of the report Understanding Psychosis and Schizophrenia Mental Health Today, Jan-Feb 2015, 22-23 https://www.academia.edu/11196191/Racialisation_and_knowledge_production_A_critique_of_the_report_Understanding_Psychosis_and_Schizophrenia

[iii] http://www.sumanfernando.com/Apology%20by%20Anne%20Cooke.pdf

[iv] Thomas, P. (2016) Psycho politics, neoliberal governmentality andausterity Self and Society http://dx.doi.org/10.1080/03060497.2016.1192905 DOI: 10.1080/03060497.2016.1192905

[v] Friedli, L. & Stearn, R.  (2015) Positive affect as coercive strategy: conditionality, activation and the role of psychology in UK government workfare programmes Medical Humanities  41:40–47. doi:10.1136/medhum-2014-010622

[vi] http://www.bps.org.uk/blog/presidential/psychology-and-unemployed 12th June 2015