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Action Group contacts & links to padlets!

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Action Group contacts & links to padlets!

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Action Group 1: Language, anti-stigma and mental health awareness

Claire Gibson: ClaireG@healthymindscalderdale.co.uk

Visit the AG1 Padlet here!

Action Group 2: Re-imagining directories & signposting

Rob Mills: RobM@healthymindscalderdale.co.uk

Visit the AG2 Padlet here!

Action Group 3: Mental health inequalities, access and transport.

Debbie Holmes: Debbie@healthymindscalderdale.co.uk

Visit the AG3 Padlet here!

Action group 4: Maintaining groups – sustainability and funding for ongoing peer-support.

Lorraine Taylor: Lorraine@healthymindscalderdale.co.uk

Visit the AG4 Padlet here!

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Download our free guide to challenge misconceptions about mental illness. Let’s end the judgement and improve lives. #LetsRethink

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Paul's research on medication & side effects

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Paul's research on medication & side effects

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Where can I find information about medication

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NSUN has today published a new resource exploring what regularly-used language in mental health means to those with lived experience of mental ill-health, trauma, and distress.

It captures the results of an anonymous survey shared with the NSUN membership in the summer of 2024, which asked people with lived experience to define a range of terms in the context of mental health.

We have brought those definitions together into this publication with the aim of celebrating the plurality of language and acknowledging that many words and terms mean very different things to different people. We hope that this resource, acting as a crowdsourced glossary of terms defined by people with lived experience, can be used and referred to by anyone who would find it helpful.

We encourage and challenge those working in mental health service provision, research, and policy work to carefully consider the power of the language that they use and the implications that it may have. This resource may serve as a starting point.

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New NSUN resource: The language of the mental health lived experience landscape

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NSUN has today published a new resource exploring what regularly-used language in mental health means to those with lived experience.

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‘Mental health culture’ is not to blame for unemployment figures

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‘Mental health culture’ is not to blame for unemployment figures

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National mental health charity: information, services & a strong voice for everyone affected by mental illness - challenging attitudes and changing lives.

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Since the appointment of PM Rishi Sunak in October 2022, claimants of disability benefits and those who are unable to work due to mental ill-health, physical health difficulties or neurodivergence have been increasingly targeted as the cause of the UK's economic issues.

Benefits, fitness for work, and long-term sickness - what's happening?

Last year, the PM argued that providing for the number of people who are not working and claiming disability benefits was 'not fair on taxpayers' and 'not good for our economy'. The following month, he emphasised his belief in the 'inherent dignity' of a good job, and described the number of people of working age who are not currently working as a 'national scandal' and an 'enormous waste of human potential'. Detailing his plans to prohibit GPs from issuing sick notes in order to reduce the number of people signed off work, Rishi Sunak, in a speech made last Friday, expressed concerns about the UK's 'economically inactive' population, claiming that the increase in people off work due to mental health issues was the result of 'over-medicalising' the 'everyday challenges and worries of life'.

It's becoming harder for benefit claimants to receive the support they so desperately need, too. Earlier this month, Resolution Foundation, an 'independent think-tank focused on improving the living standards of those on low-to-middle incomes' published research into the impact of the Universal Credit system roll-out, which has been replacing legacy benefits since its introduction in 2013. According to the research, disabled people - and in particular those who are single, do not have a full-time carer and are unable to work due to their disability - can be 'around £2,800 per year worse off on Universal Credit in 2024-25 than on legacy benefits'. This places people unable to work due to a disability or health condition at an increased risk of poverty, especially at a time when the majority of those applying for Personal Independence Payment (PIP) do not receive the benefit, and planned changes to Universal Credit will prevent claimants from receiving additional income to support their disability or health condition unless they are also in receipt of PIP.

It's a frightening time to be someone claiming benefits, and a frightening time to be someone who cannot work. We're watching the prime minister of the UK drip feed a nation with an extremely ableist rhetoric intended to radicalise, scapegoat and ostracise. We are being demonised for our suffering - and for those of us who experience mental ill-health and distress, our suffering has been openly ridiculed and minimised. The narrative that disability benefit claimants are lazy, fraudulent or 'leeching' from taxpayers is louder and more unashamedly public than ever.

Who is affected, and what's the effect?

The real depth and scale of the impact of the Government's torrent of criticism towards disabled people is difficult to measure, and may not become apparent for many years, but for people like me and those whose words are collated in this blog - people who rely, or have relied on benefits to live - the impact is both immediate and immense.

I started receiving PIP aged 18 whilst living in a therapeutic community for people with eating disorders, having spent the last five years of my life surviving incapacitating mental illness and the last two years of my life detained in psychiatric hospitals. I hadn't been able to work before this point and was still not well enough to work, so PIP helped me to engage with the world in ways I couldn't have done otherwise, for instance, by enabling me to study at college. After COVID-19 lockdowns had ended in 2021, I applied for Universal Credit, which provided me with the means to start a degree with the Open University and live independently of the therapeutic community. Over the next two years, I tried (and struggled) to hold down work - benefits kept me financially secure whilst I attempted to find a job that I could do, and that would employ me despite my patchy employment history, lack of experience and lack of qualifications at GCSE level and above.

My PIP claim was reviewed last year and, after a brief phone conversation with a medical professional I had never met, it was decided that I was no longer eligible for PIP. At the time I was a part-time student, which meant I was only entitled to Universal Credit if I was in receipt of PIP - without PIP, I was not eligible for Universal Credit, and all the income I had was gone. Just like that. Without any notice, without any warning, without any support. A complete stranger had decided that I didn't deserve money to live on.

Unfortunately, I'm not alone in being unexpectedly removed from benefits. I connected with five current or previous claimants through social media, each with a story to share about their experience of claiming benefits, like Katie* - Katie isn't sure why she was taken off her PIP a few years ago, because she was never given an 'official reason'. She believes they decided, without speaking to her, that she was no longer in need of it. At the time, PIP was Katie's only income, and having it removed left her in 'great financial difficulty'. Katie says being taken off PIP made the issues that had meant she had to apply for PIP in the first place worse: 'I did feel awful. It was like my issues were being minimised even though they affected me day to day significantly'.

Paula also stopped receiving benefits several years ago, but this took place at her own request. Despite experiencing significant mental ill-health leading to hospital admissions and a placement in a therapeutic community (where she was receiving treatment at the time she applied for Universal Credit), Paula felt guilty about being in receipt of benefits as a result of negative external perceptions of benefits, particularly revealed in posts and comments on social media. And it's not hard to see why - scrolling through the comments on a recent BBC article into Universal Credit (UC) and long-term sickness, perceptions of those receiving benefits can be extremely dismissive and cruel, with many commenters particularly targeting those who are out of work due to mental ill-health:

After just five months of receiving UC, Paula wrote that she felt she 'didn't deserve' benefits in her online journal; without any further assessment of her needs, her claim was immediately cancelled.

Universal Credit "journals" are a part of the online UC system where claimants can make contact with their work coach. The journal isn't computer operated; messages are seen and received by real people working for the DWP. This means that a human being read Paula's message, and, rather than instigating a welfare check or reassuring her that the benefits system was created to support people in her position, they decided that her claim should be cancelled. The lack of compassion, empathy or understanding in this decision is horrifying and reflective of a government that, in the words of our prime minister, aims to prevent 'economic inactivity' and stop young people getting 'parked on welfare'.

For those who are 'parked on welfare', the threat of having benefits removed is real and constant. Phoenix, who is unable to work because of his disability, recently had his benefits taken away from him because of a prolonged hospital stay. This is standard practice for PIP recipients - if a claimant is admitted to hospital for a period of four weeks or more, their claim stops until they are discharged (see here for more info).

When Phoenix started receiving PIP in 2020, he received no other help or additional support - but as soon as they wanted to remove his benefits, Phoenix described receiving pressuring letters 'every other day'. Phoenix believes his health deteriorated because of both the toll of having his PIP taken away from him, and the stress of being a benefit claimant: 'My mental health got worse because of PIP for a while, because of just the way that I was treated - they treated me like shit. The whole process made me feel like I was begging. It was awful. I hated it. And I have to go back on it when I leave - I'm dreading it. I honestly feel like the PIP process made me more sick."

Phoenix wasn't the only person I spoke to who found the process of claiming for PIP or other disability benefits distressing in itself. Katie explained that although she could have appealed the DWP's decision to remove her benefits, she 'didn't want to have to go through the process of being degraded all over again'. Mae, who has been a Disability Living Allowance and PIP claimant since she was 15, described the process of applying for and being on benefits as 'horrible', 'invasive', and 'not easy at all'. She also feels aware of the threat of having her benefits removed: 'My PIP was reassessed only a couple of months ago. The stress and terror of having it taken away was awful. Because it's not just "money" (it's really not even that much) - I rely on it to keep myself as well as I can whilst being at uni. As an autistic person who also has mental and physical health problems, working whilst being at uni just isn't possible for me, and without my PIP, I wouldn't be able to afford to be at uni.'

It's no surprise, then - considering the humiliation, terror and disempowerment that the DWP puts disability claimants through - that some people choose to take themselves off benefits, despite being in desperate need of them. Lucy, who was a PIP claimant for 8 years, chose to come off benefits recently when the DWP informed her that her PIP was due for a review. She felt that, despite the complexity of her needs and experiences, the DWP would now view her as 'fit for work', and her entitlement would end: 'When I left inpatient care, I ended up with no adult mental health or social care team, which I knew meant I wouldn't be able to get the evidence that [the] DWP would ask for at my review. My experiences have led me to need a different kind of employment - when you apply for benefits, nobody tells you that 9-5 office hours might not work for you because of how complex your needs are, nobody suggests self-employment or running a small business; nor do the DWP or care teams really actively support and help people to do so. Now I'm in a position where I've got no employability skills and no experience because I've been institutionalised and out of work and education for 10+ years, but I know my needs don't fit the parameters of what PIP would assess - so in some ways I'm not eligible, but I should be. If I turned around and said to PIP, you're lucky if I can get a full night's sleep once a week, you're lucky if I can go shopping for basics or take the dog for a walk, I'd still be seen as 'fit for work'.'

Lucy feels that the benefits system as a whole is unable to meet the needs of those who are relying on it for income, and fails to adequately assess people's needs in the first place: 'It feels like you're a puppet on a string. If the DWP were really trying to support people, they'd be helping people into meaningful occupations that actually meet claimants' needs on an individualised basis. They're not looking at the person as a whole, who needs support and time to find something meaningful that may also generate income for themselves. That's what getting people 'back to work' should be about. Instead, they just give you the money and then you're waiting year after year for when the next review will happen. It's like dealing with an abusive partner - knowing that they're out there, watching, and could contact you at any minute to turn your world upside down and take away everything you've got."

One of the most abhorrent things that has come out of our government's latest deluge of abuse directed at the disabled and those who experience mental ill-health and distress is the pigeonholed image of young people out of work due to long-term sickness depicted by Rishi Sunak at his speech last Friday, who were described as 'a generation of young people [sat] alone in the dark before a flickering screen watching as their dreams slip further from reach every passing day'.

It's the typical Conservative 'snowflake' insult, intended to generate a combination of hatred, pity, disgust and shame. It's language that portrays those of us who cannot work as lazy, self-absorbed, and responsible for our own "imagined" illnesses; if only we'd just turn off the telly, turn on the lights, and start providing for ourselves. Once again, we're viewed as synonymous with frauds and parasites; not content with sucking the light out of our own lives, we must make it the problem of the good old tax-paying British population.

The reality for those of us who claim benefits and/or who are unemployed due to disability or ill-health could not be further from the prime minister's words. For most of us, like Mae, whose benefits currently enable her to study at university, being on benefits creates a platform from which we can build or rebuild our lives - whilst I was receiving PIP, I had the capacity, energy and finances to co-establish an organisation for young people who have experienced iatrogenic harm. I was an organiser for a vigil to commemorate the closure of an abusive inpatient unit. I co-wrote and illustrated a book which amplified the voices of ex-inpatients at children's psychiatric hospitals. I worked different jobs, studied academic courses, started my own novel, and generally - using Rishi Sunak's words - was as "economically active" as I have ever been, far more so than I am now that my benefits have been taken from me.

Nobody wants to be the victim of an oppressive system that makes those who rely on it believe they are a burden to the society we live in. People don't claim benefits because they want to - disability claimants need the income they receive from benefits to survive. Pushing people off benefits isn't going to fix a broken economy, and it certainly won't help the country "level up"; the only way the welfare system can be effective is if the systems that surround it - social care and the NHS - are effective, too.

A growing population of people who are unemployed due to long-term sickness doesn't reflect a growing population of layabouts and cowards. It reflects a government that has failed to protect, improve and expand its national healthcare to meet the needs of a suffering population.

*Some of the names of those whose words are included in this blog have been changed to protect their identities.

Nima Cas Hunt (she/her) is a writer and co-founder of non-profit group First Do No Harm. She is committed to ensuring the voices of those with lived-experience of mental ill health and distress are actively involved in the design of mental healthcare, and a firm believer in the power of services that move away from the pathologising of distress. Her Twitter/X is @nimacashunt.

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'Like a puppet on a string': The 'sick note' culture, from those who live it

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Pushing people off benefits isn't going to fix a broken economy, and it certainly won't help the country "level up"; the only way the welfare system can be effective is if the systems that surround it - social care and the NHS - are effective, too.

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mock tabloid newspaper published as part of Mind's campaign to ensure people with mental health problems are treated fairly under the Coalition Government's welfare reforms.

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Few things are ever really new. British politics - and the media ecosystem that maintains it - effectivelyregurgitates the same talking points on repeat, a kind of Groundhog Day where the key players may appear different but familiar destructive patterns are ever-present.

It is exactly a decade since former chancellor George Osborne launched cuts to the benefits system totalling tens of billions of pounds, and with them, fuelled rhetoric so toxic that it caused an increase in hate crime towards disabled people. This was the era of Benefits Street and the Sun's Beat the Cheat campaign, where it was quite normal for a national newspaper to invite readers to report their disabled neighbours to the benefit fraud hotline.

Fast forward 10 years and we bleakly find ourselves back here again, with labour shortages and a population in ever poorer health. Now politicians and the media are setting their sights on the so-called "economically inactive" and "record numbers" of long-term sick. "Millions paid benefits without ever having to find a job," a recent front page in the Daily Telegraph proclaimed. It has the frenzied air of a piece of investigative journalism that has uncovered some sort of organised fraud racket.

In fact, what they've discovered is the welfare state: these "millions" are simply people who are too disabled or ill to work, with sickness benefits being rebranded as "jobless benefits". Forget the research showing how hard it is to get disability benefits or the number of people who die after being found "fit for work". The dog whistle is a familiar tune: hordes of disabled benefit claimants could hold down a job if only they weren't so idle.

Or as Channel 5's Jeremy Vine Show recently put it in a debate about "cracking down" on "jobless benefits" for sick people: "Is it wrong for taxpayers to fund them indefinitely?" This is what the boundaries of legitimate debate being pushed looks like: TV audiences being asked to weigh in from their living rooms on whether minorities are worthy of state support. Before you know it, "should we leave the disabled to starve to death?" is just a rational form of fiscal inquiry.

It does not take a scholar of history to know that times of economic crisis bring the vilification of marginalised groups. Like the financial crash a decade ago,the cost of living crisis of recent months has combined with gaps in the labour market to create prime conditions for demonising those whose health means they cannot earn a wage.

Rather than structural issues of soaring NHS waiting lists, a pandemic, migration rules, or disability discrimination in the workplace, having ME or depression is portrayed as an individual failing. Even the term "economically inactive" is a loaded term - a capitalist value judgment against people whose bodies "fail" to be productive and therefore useful.

That increasing numbers of families are working all day and still unable to put food on the table makes this particular story all the easier to sell. The wink to the camera is clear: while you're struggling to pay the electric bill with your hard-earned wages, hordes of scamming benefit claimants are living the life of Riley off your taxes. The Department for Work and Pensions' own research showing that some disabled people can't afford food or heating on their benefits is, apparently, irrelevant.

Being in too much pain to get out of bed for work is seen not as a trauma to empathise with, but a privilege to envy. As a cleaner forced to use food banks implored on last week's Question Time: "It seems like the unemployed get ... freebies, while there's no incentive for those of us who do work, who do try. What do we get?"

The benefit of all this for those in government and their backers is clear enough: shift responsibility away from the policy failures that have actually caused the problems, while distracting the population with a scapegoat. The DWP Twitter account posting footage of "raids on benefit fraudsters" - featuring a cabinet minister in a stab-proof vest - is a particularly crass demonstration, a pantomime that offers a digital crowd a villain to boo.

Seen through this context, the baiting headlines emerging in recent weeks are not some innocent error - they are exactly as intended. Sometimes, a mob's pitchforks can look a lot like a broadsheet front page.

Perhaps there is some hope; contrary to the media narrative, at least two-thirds of people think universal credit rates are too low. And yet the conditions of the past decade - Brexit, a pandemic, lower living standards - point to a future of more instability and division, not less.

A growing consensus within the political class has blocked any real change in attitudes towards social security from happening. Instead of challenging rightwing tropes, the opposition is highlighting barely existent benefit fraud.

More gravely, the collective failure to provide any real answers to people's problems will only encourage the public to find other places to lay their resentment and blame.

In this climate, sick and disabled people are not so much human beings with needs and feelings as burdens on the state. The ease with which we keep returning to this conclusion as a society deserves as much attention as how we can change the narrative. What we can be sure of is clear: those with power and resources will always be ready to stoke the worst of our instincts to hurt those with neither.

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A decade after the Tories demonised disabled people on benefits, it's happening again | Frances Ryan

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Never mind that the DWP itself found that some disabled people can't afford food or heating, politicians and the media need scapegoats, says Guardian columnist Frances Ryan

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Andy Bell: What's driving the backlash against mental health awareness? by Centre for Mental Health

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Has mental health culture gone too far? Thea Joshi welcomes Andy Bell to unpack recent comments from government ministers and proposed plans to reduce access to benefits for people taking time off work for their mental health. They discuss what's driving this backlash, and explore where we're actually at on our journey from mental health awareness to mental health literacy.

If you appreciated this episode, we'd love your support to keep our work going - please donate today: www.centreformentalhealth.org.uk/donate

Music by scottholmesmusic.com

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Sunak’s lies about UK disability benefits system are to justify cutting access to them

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I have spent the majority of my working life working with people who have struggled with mental and physical health problems, who have had to depend on the benefits system to be able to live day to day.

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Rishi Sunak is considering withdrawing a major cash disability benefit from some people with mental health conditions, prompting claims he has launched a "full-on assault on disabled people".

The prime minister announced fresh curbs on disability benefits on Friday, saying he wanted to explore whether some cash payments to claimants with mental health conditions could be replaced by treatment or access to services.

In a speech on welfare, Sunak said he was launching a consultation on the personal independence payment (Pip), a non-means-tested benefit paid to disabled people to help with the extra living costs caused by long-term disability or ill health.

He said that in addition to reviewing payments to people with mental health conditions, the government would look at whether some other disabled people should get help with one-off costs rather than continuing payments.

The announcement triggered an outcry from disability charities, which said the rates of people being signed off work and claiming benefits were being caused by crumbling public services, poor-quality jobs and high rates of poverty among disabled households. Mind, the mental health charity, said services for mental health conditions were "at breaking point".

There are 1.9 million people on a waiting list for mental health treatment in England, meaning the treatment they should be able to access through the NHS is not currently available to them.

Sunak said Britain was proud to have a strong safety net of welfare payments to those who needed them, but he also said the country had a "sicknote culture" that needed to be tackled.

He said "something has gone wrong" since the pandemic to increase the number of economically inactive people who are long-term sick, especially with mental health conditions.

"Most worrying, the biggest proportion of long-term sickness came from young people ... parked on welfare," Sunak said.

He said the country could not afford the "spiralling" disability welfare bill of £69bn, which was now more than the core schools budget, and claimed the Pip budget was forecast to increase by 50% in the next four years.

Other measures he set out included:

Shifting responsibility for issuing fit notes, formerly known as sicknotes, away from GPs to other "work and health professionals" in order to encourage more people to return to work.

Confirming plans to legislate "in the next parliament" to close benefit claims for anyone who has been claiming for 12 months but is not complying with conditions on accepting available work.

Asking more people on universal credit working part-time to look for more work by increasing the earnings threshold from £743 a month to £892 a month, so people paid below this amount have to seek extra hours.

Confirming plans to tighten the work capability assessment to require more people with "less severe conditions" to seek some forms of employment.

On the review of Pip, Sunak said it may be right to pay one-off costs for adaptations, but that the payments may not need to be ongoing.

The prime minister said the government would look at whether more medical evidence about conditions should be provided, as some payments were made on the basis of "subjective and unverifiable claims".

He said some people with mental health conditions may be better served by treatment and access to therapies rather than cash payments.

Sunak also warned about the "the risk of over-medicalising the everyday challenges and worries of life" when it came to paying benefits to people with mental health conditions.

UK needs to change 'sicknote culture': Sunak targets disability benefits - video

His comments were echoed by Mel Stride, the work and pensions secretary, who told Sky News on Friday: "If you go to the GP and say you are feeling a little bit depressed, and you're signed off, in 94% of occasions, a box is ticked that says you're not capable of work whatsoever.

"What we want to do is change the system so that that individual will be referred to - the government is setting up something called Work Well - where they will get both the healthcare support they need, but also a work coach who will be involved to either help them stay in work if they are in employment, or to help them get into work if they're not."

Ed Davey, the Liberal Democrat leader, said: "Millions of people are stuck on NHS waiting lists, unable to get a GP appointment or struggling to access mental health support. Rishi Sunak is attempting to blame the British people for his own government's failures on the economy and the NHS and it simply won't wash."

Matthew Pennycook, the shadow housing minister, said Sunak had been pursuing a "cheap headline" over his claims that Britain has a "sicknote culture".

"There has been a long-term rise for many, many years under this government in people who are on long-term sickness benefits, either because they can't get the treatment they need through the NHS, which is on its knees after 14 years of Conservative government, or they are not getting the proper support to get back into work," he said.

Charities warned that the benefit curbs would make people's problems worse. James Taylor, the director of strategy at the disability equality charity Scope, said the speech "feels like a full-on assault on disabled people".

"These proposals are dangerous and risk leaving disabled people destitute," he said. "In a cost of living crisis, looking to slash disabled people's income by hitting Pip is a horrific proposal.

"Calls are pouring into our helpline from concerned disabled people. Life costs more for disabled people. Threatening to take away the low amount of income Pip provides to disabled people who face £950 a month extra costs isn't going to solve the problem of economic inactivity ... Much of the current record-levels of inactivity are because our public services are crumbling, the quality of jobs is poor and the rate of poverty amongst disabled households is growing."

Dr Sarah Hughes, the chief executive of Mind, said the mental health charity was "deeply disappointed that the prime minister's speech today continues a trend in recent rhetoric which conjures up the image of a 'mental health culture' that has 'gone too far'.

"This is harmful, inaccurate and contrary to the reality for people up and down the country," she said. "The truth is that mental health services are at breaking point following years of underinvestment, with many people getting increasingly unwell while they wait to receive support. Indeed the Care Quality Commission's latest figures on community mental health services show that nearly half of people (44%) waiting for treatment found their mental health deteriorated in this time."

Iain Porter, a senior policy adviser at the Joseph Rowntree Foundation, said the prime minister had launched an "irresponsible war of words on people who already aren't getting enough support, which the government would rather not talk about".

"Many people want to work, as the prime minister says, but have their hopes dashed by woeful health and wellbeing support and job centres unfit for purpose," he said.

The British Medical Association said the prime minister should focus on getting people access to the medical help they needed to get back to work rather than "pushing a hostile rhetoric on 'sicknote culture'".

This article was amended on 19 April 2024. A previous version said the earnings threshold was increasing from £743 to £892 a "week", rather than a month.

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Sunak accused of launching 'full-on assault on disabled people'

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PM criticised for personal independence payment review amid 'spiralling' disability welfare bill

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This piece was written by The Migrants' Rights Network in collaboration with NSUN as a contribution to MRN's Words Matter campaign, which aims to explore the ramifications of certain language, and to show solidarity to migratised communities by standing up against harmful narratives.

The language of vulnerability is often used in conjunction with migrants and other marginalised groups. While many migrants are made vulnerable by the structures they interact with (e.g. immigration systems) or as a result of traumatic experiences which can result in ill health or disability, they are often generalised as being an inherently vulnerable group. Migrants, including refugees, are given the blanket label of 'vulnerable'. While it's sometimes important to 'prove' vulnerability, so that migrants who have been made vulnerable can access support services, such as mental health services or gender-affirming care for trans+ migrants, the term 'vulnerability' has become something of a buzzword. This word is applied very individualistically, rather than interrogating the harmful systems or conditions that create vulnerability.

'Vulnerability' manifests in very different ways depending on the group or person in question, and we must apply an intersectional approach when exploring how vulnerability is created. Under oppressive systems, gender, sexuality, disability, race, ethnicity, religion or age can all intersect, which defines how vulnerability is constructed , and who has access to the support they need. As part of our Words Matter campaign, we're exploring the concept of 'vulnerability', in relation to disability and migration, with our friends at the National Survivor User Network (NSUN).

Should we think of and describe people on the move as 'vulnerable'?

While the concept of vulnerability is commonly referred to in conversations around migration, it is often incredibly malleable and poorly defined. Vulnerability most often presents itself as a vague state of passive, apolitical victimhood imposed by Western organisations and governments onto racialised groups. Even a 2018 report from the Independent Chief Inspector for Borders and Immigration into the Home Office's approach to safeguarding 'vulnerable' adults highlighted how using the word risks 'locat[ing] the cause of abuse with the victim'.

The idea of the inherently vulnerable individual also enables the 'White Saviour' complex. The predominantly White-led charity and aid sector can dictate who is constructed as 'vulnerable' and therefore what is needed to support that person. This reinforces the problematic power dynamic in support services and charities because it takes away the agency or decision-making abilities for marginalised groups to dictate what resources they want or need.

There are no inherently 'vulnerable' migrants, only those who are made vulnerable and kept in precarious situations by oppressive systems.

We reject the labelling of people on the move as 'vulnerable' as this implies an inherent lack of agency and control over their own lives. Describing people as such obscures the structures that keep migratised communities precarious, such as the lack of safe routes to seek asylum in the UK, prohibitively expensive visa application processes and the encroachment of border enforcement into our schools, hospitals and workplaces.

People seeking sanctuary from across the Global South may also be constructed as 'vulnerable' because of political or economic instability in their home countries. Once again, this obscures that vast areas of the world have been destabilised by centuries of colonialism and military intervention by the Global North. These processes are not apolitical, but the direct results of policy decisions made by Western governments past and present.

What else does 'vulnerability' imply?

The passiveness that 'vulnerability' tends to denote when it is applied to migrants lends it a distinctly gendered quality. Often, meek, 'vulnerable' women and girls on the move are constructed in opposition to hostile, 'fighting age' men in similar situations. Both of these categories are reductive and harmful; one denying people's agency and the other playing on discriminatory tropes to justify inhumane migration policies.

There have been efforts within some humanitarian organisations to expand understandings of 'vulnerability' to acknowledge specific challenges faced by men seeking safety. While beginning to deconstruct 'vulnerability' is a step in the right direction, this does not go far enough.

Who decides who is 'vulnerable'?

Even when it is made more inclusive, the concept of 'vulnerability' remains an artificial one that is imposed on racialised migrants from the Global South. Instead of allowing people on the move to define their own needs, it only serves to justify more oppressive Western humanitarianism. This means that people from the Global North continue to make decisions about migrants' lives.

We also know that members of migratised communities that are dependent on humanitarian aid are well aware of Western conceptions of 'vulnerability'. This can lead people in these situations to 'perform powerlessness' at the expense of expressing their actual opinions and needs.

Vulnerability is complex, and looks different for everyone. Passively applying the term 'vulnerable' to entire groups can both dismiss and infantilise them. Instead, we should look at the systemic issues that create and exacerbate vulnerability so that we can collectively tackle the root causes that expose people to risk or harm.

We are exploring the relationship between migration status, immigration systems and disability through our Who is Welcome: Disability and Migration campaign.

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This piece was written by The Migrants' Rights Network in collaboration with NSUN as a contribution to MRN's Words Matter campaign, which aims to explore the ramifications of certain language, and to show solidarity to migratised communities by standing up against harmful narratives.

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Speaking out on the stigma of mental health

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WHO’s primary role is to direct international health within the United Nations’ system and to lead partners in global health responses.

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From Paul: 'Language used in mental health matters' 21/01/24

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From Paul: 'Language used in mental health matters' 21/01/24

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See attached for Paul's recent research and writing on lanugage.

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'Sexy But Psycho: How the Patriarchy Uses Women's Trauma Against Them' - Dr Jessica Taylor

The audiobook is on Audible here at £7.99 - £12.99 (price depending if you are a member on Audible or not)

Georgia bought the ebook on Google Play here for £2.99

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Check out this great listen on Audible.com. The Sunday Times best seller. Angry, opinionated, mouthy, aggressive, hysterical, mad, disordered, crazy, psycho, delusional, borderline, hormonal.... Women have long been pathologized, locked up and medicated for not conforming to whichever norms or ste…

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From Paul: 'Working with stigma' 15/01/24

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From Paul: 'Working with stigma' 15/01/24

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Paul's personal piece on generational attitudes to mental health.

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By Akiko Hart

On Sunday, it will be World Mental Health Day. Again.

NSUN is a mental health charity, but on World Mental Health Day, or #WorldMentalHealthDay, we'll be quiet.

It doesn't speak to us, or to many of our members.

World Mental Health Day is about awareness raising. But of what, and to what end?

World Mental Health Day is a global awareness campaign whose theme is set by the World Federation for Mental Health. This year's theme is "mental health in an unequal world", a surprisingly political choice.

But NSUN members are more than aware of mental ill health, distress or trauma: they live with it every day. NSUN members don't need to be told that mental health is important. Nor do they need to be told it's good to talk (it's not, always); that there is always help available (false); that we are not alone (actually, we often are). In fact, it's way past time to talk: it's time to scream.

In the UK, anti-stigma awareness raising campaigns such as Time to Change or Heads Together have done their job. More people seem aware that mental health is a thing, and a thing to be taken seriously. We've seen a real generational shift in how mental health is talked about in the UK, and that is partly down to these campaigns. Are there still some people who are not aware? Yes, of course. Maybe World Mental Health Day is for them, but somehow, I'm not so sure.

So, who is World Mental Health Day for?

On the face of it, World Mental Health Day is aimed at people for whom thinking and talking about mental health is a newer or more tangential part of their lives. Clearly, it brings a lot of people joy and connection. But the fact that it's a one-off day which aims to bring people together to talk about mental health is also why it doesn't land with people who live with this stuff day in and day out and who don't get a holiday from themselves. It doesn't feel new or energising to them, and most of the content or conversations being generated isn't aimed at them.

A lot of the space #WorldMentalHealthDay occupies is actually in the corporate sphere. The hashtag is deployed by organisations as a signalling tool, to show that they too care about mental health. But if organisations are serious about tackling stress and burnout in the workplace, or supporting employees who live with mental ill health, then retweeting a message about how mental health matters or how it's good to talk probably isn't going to do it. It's likely to be more about the structures you have in place, resourcing, ongoing support, the culture you build and how you treat people. How many people in corporates are adding "say something about #WMHD on my LinkedIn" to their ever-expanding to-do list?

The truth is that World Mental Health Day is good for business, if you are in the business of mental health. It's a hook for your campaign or your new product. It's a convenient way of launching a new partnership. It's a way of showing your stakeholders and donors and partners that you are "starting a conversation". Which is fine. Mental health is a big ecosystem, and different parts of it will speak to different people.

#WorldMentalHealthDay is in fact a bit of an industry. It generates actual jobs, it triggers endless meetings and frenetic activity. And, crucially, it raises money.

I'm interested in how much of the money raised on #WorldMentalHealthDay goes towards say, actual service delivery, or your local mutual aid group. I wonder if in fact the bulk of the funding is funnelled back into these campaigns to raise more awareness of mental health so they can invest in a bigger campaign next year to raise more awareness. And if that's where you want your money to go, then great. But this is the crux of the issue.

World Mental Health Day and similar initiatives are not just harmless campaigns with some beneficial by-products. By their nature they simplify complex issues, and privilege clean and easy messages over difficult ones. They take up space and suck up oxygen. They pull resources and funding and attention towards some parts of mental health and away from others.

People, organisations and governments have limited attention spans. I don't expect everyone to care about mental health, but it makes my job harder when I am constantly untangling received wisdom about mental health from these campaigns.

To put it bluntly, World Mental Health Day diverts attention and resource away from many of the issues that NSUN members care about, and makes it slightly harder for us to make the case for them.

When people who think and talk about mental health every day are muting #WorldMentalHealthDay, we need to pause and reassess who the day is really serving.

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Why NSUN doesn't do World Mental Health Day

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NSUN members don't need to be told that mental health is important. Nor do they need to be told it's good to talk (it's not, always); that there is always help available (false); that we are not alone (actually, we often are).

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Recommended reading - chapter from 'Sedated' - James Davies

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Recommended reading - chapter from 'Sedated' - James Davies

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You could skip to the fourth section down to the paragraph beginning 'On 19 February 2018...' and read from there if you don't feel up for reading the whole thing.

Discusses the rise of mental health consultancies such as Mental Health First Aid and how these have not necessarily been a good idea.

Touches on why we need to be careful with 'mental health awareness' as it can perpetuate the idea that it is up to individuals to deal with their own "illness" rather than focussing on the environment causing people distress.

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From the 1980s onwards, working life in the West underwent a seismic shift. As the manufacturing sector that had dominated the British economy during the era of regulated capitalism was gradually dismantled (shrinking from 40 per cent of the economy in the 1970s to a mere 10 per cent today), there was an explosion under new capitalism in the service sector, that part of the economy whose primary aim is not to make things, but rather to sell things; the things we consume daily: goods, services, health care, leisure, tourism, education and financial services. As the manufacturing sector dried up, the service sector gradually boomed, until by 2018 it was consuming a remarkable 80 per cent of the British entire

The national lurch towards the service sector brought profound changes to the working lives of the UK population, placing on it new and unique demands. Some of these demands were obvious from the start, as they could be easily measured. Firstly, from the 2000s, the average number of hours people worked began to rise considerably, as overtime became almost obligatory in the new twenty-four-hour services Secondly, as the service sector demanded more flexible workers, who could move jobs with ease, the average length of time spent in any given job dropped by around a - with the average employee now changing jobs once every six Since 2015, such required flexibility has also fuelled the rise of the 'gig economy', where nearly five million people in the UK now work on temporary or day-by-day contracts, enjoying no secure Finally, as the service economy largely operated in urban centres, where property prices had grown most steeply, more of us began seeking cheaper homes in suburban settings, increasing the average time we spend commuting each week to nearly five hours (or closer to seven hours for In short, these changes mean we now work much longer, commute much further and move jobs much more frequently than we did in the previous four decades.

While these changes have had significant knock-on effects for community cohesion, our personal and family lives, our sense of job security and our emotional health, there were other changes to our working lives whose consequences were more profound still. These changes concern the demands now being placed on employees from within the workplace itself - demands that go to the very core of the kind of people we are. Today, in very particular ways, the modern worker looks, feels and behaves very differently to the average worker of the past, and this has had, as we will see, profound implications for the mental and emotional health of our current working population.

In the mid 1980s, as the service sector expanded, a problem arose that soon began costing businesses millions of pounds a year: too many people, after being hired, turned out to lack the personal qualities required to get the job done. This meant that employers could either try and dismiss newly hired staff (and, if successful, initiate costly rehiring processes) or invest heavily in employee training, in the hope of instilling the qualities workers lacked.

As companies from London to Boston, Manchester to New York grappled with this problem, a simple yet revolutionary idea soon emerged: why not just ask all candidates to sit a personality test as part of their initial job interview? This way companies could better protect against making costly mistakes, by testing for the character traits they most desired in prospective employees and weaning out those who failed to fit the desired psychological profile. These personality tests, first deployed by a handful of companies in the 1980s, rapidly caught on, until by 2014, 80 per cent of all Fortune 500 companies were using while between 13 and 65 per cent of all new job applicants in the UK and US were being required to undertake them, depending on the

In 2017, I met one such applicant in a busy café in London's Sloane Square after a mental health seminar I'd run for a group of young playwrights at the Royal Court Theatre. Natalie, a talented twenty-four-year-old writer, was keen to tell me about the struggles of getting her writing career off the ground. Having little money, status or job security, she'd taken on temporary work in the City of London, writing her plays late into the night as her partner slept. As we spoke about her work in the City, I returned to the topic of personality tests, something I'd briefly touched upon in the seminar. 'The damn thing about those tests,' shot back Natalie, 'is that I was rubbish at taking them. I would sit there and try to answer the questions very honestly - as a writer I can be introverted, wild, creative, unpredictable, rebellious. So I'd put it all down. But then I never got the job - what the hell! It was all very demoralising.'

She soon became savvy to the art of personality testing after doing a bit of online research. 'There are literally hundreds of websites telling you how to cheat the tests, telling you what boxes to tick depending on the job you're going for. They claim that if you want a job you have to fake it - imitate the person your employers probably want. I learnt very quickly that earning a bit of money depended on being a very good impostor.'

Natalie recounted all this cheerfully, but behind the facade she felt guilty about duping the system; about feigning a particular personality to get a job. The plain truth is that she is not alone in faking assessments to gain an edge in the employment market. As the largest and most recent study on personality testing revealed, over half of all participants game the tests, emphasising traits they believe are desirable while hiding those they fear could jeopardise their job In other words, Natalie belongs to a vast pool of people embroiled in an elaborate personality game, where winning relies upon your capacity to identify and perform the persona your prospective employers may most desire.

When I raised the topic of personality tests with Dr David Frayne, a leading authority on work psychology and a fellow at New York University's prestigious Global Institute for Advanced Study, he was clear about the growing obsession with personality in the modern workplace: 'In the more industrial economy of the pre-1980s, it was relatively easy to spot the productive employees in your workforce,' he told me. 'You just measured how many units or items they made per hour of their labour, and worked back from there. But as making things became less common in the new services economy, output became more immaterial, less easy to pin down, making the actual productivity of workers far more difficult to assess.'

So from the 1980s onwards, big business began devising new ways of gauging the precise kinds of employees most likely to thrive in the new services economy: 'They soon realised that making profit was now directly connected to the actual conduct of their workers - their capacity to deliver a service with a smile, so to speak,' continued Frayne. 'So they focused more on our personal characteristics, on our character, our professionalism and displays of commitment to the company, which led to a deeper regulation and monitoring of our conduct: of how we look, relate and act.'

While different jobs demand slightly different worker qualities, the 'good worker' is broadly someone who demonstrates, as Frayne wrote, 'mastery over the social norms of professionalism, displaying commitment, enthusiasm and an alignment with the goals of the In essence, companies are after those deemed to be team players, optimistic, friendly, aspirational, extrovert if possible, and not too intransigent. Such people are considered good for a company's image, profits and esprit de As the culture of work changed over the 1980s and 1990s, our concept of the good worker changed too; a concept putting greater emphasis on who you are or who you appear to be, rather than on what you do or produce.

On 5 January 2015, commuters on the London Underground encountered a curious sight in the curved ad spaces located above their seats. On train after train these spaces were filled with bright yellow posters, each containing one of the three following sentences, all written in bold Helvetica script:

While you'd expect most people to smile wryly at yet another oddity on the Tube, that's not quite how things played out. The posters rather set off a Twitter storm, as thousands of people began posting and vigorously discussing the statements online. The anonymously distributed posters, it soon became clear, had hit a deep chord on the morning commute.

Around the same time as the posters were issued, I was involved in a research initiative at the University of Exeter exploring the relationship between mental health and work/life balance. As part of my contribution, I'd started focusing on the sentiments expressed in the posters - a proliferating sense of deep worker dissatisfaction and meaninglessness. As I began exploring the academic literature, in particular, on how such dissatisfaction was being interpreted and managed in our workplaces, the Tube messages seemed uncannily prescient.

Despite the different measures and definitions used in the studies I consulted, they all consistently showed that the highest numbers of employees (around two-thirds) were located in the 'not engaged' or 'dissatisfied' This meant that the majority of UK workers experienced no positive emotional engagement in the work they did (it left them emotionally cold, so to speak) and/or they simply disliked their jobs (they were dissatisfied, bored or unhappy at work). This was also consistent with more recent research from 2018 revealing that around 55 per cent of Brits feel under excessive pressure, exhausted or regularly miserable at and that nearly 40 per cent feel their jobs make no meaningful contribution to the world. More startling, 46 per cent of men say they believe their jobs to be entirely In short, and to amend slightly one of the Tube posters, not only do huge swathes of us spend our days performing tasks we secretly believe do not really need to be performed, but a significant proportion of us also find our work meaningless, dissatisfying and/or emotionally disengaging.

Levels of worker dissatisfaction and disengagement show some striking changes over time. For example, since the 1970s, these figures have continued to rise - by between 8 per cent and 19 per cent depending on the study So while levels of dissatisfaction weren't ideal in the 1970s, they have become much worse. But more than this, such rising worker dissatisfaction and meaninglessness is now also closely related to another problem that has persistently vexed the UK economy - a problem the personality tests were originally designed to address: ailing worker productivity. As worker discontent gradually went up nationally, growth in output or productivity gradually went See-saw-like, the two trends, the research shows, are inversely related.

As companies were busy trying to recruit the right types of people, the wrong kinds of workplace emotions were now creeping in - dissatisfaction, disengagement, meaninglessness and futility - emotions that were hurting balance sheets far and wide. If personality tests could not protect against these costly workplace emotions, then perhaps other interventions needed to be embraced that targeted these emotions directly. Growing worker distress was therefore opening up a potentially vast new market, one that would be highly profitable for any industry that could claim to reduce these growing levels of worker dissatisfaction.

By the mid 2000s, numerous mental health consultancies had begun developing, packaging and selling their well-being programmes to offices and workplaces far and wide, to a diverse range of employers in both the private and public sectors. Mental health and other initiatives would gradually spring up across our working environment, until what was initially a scatter of outlier courses and schemes would, over the next ten years, spread to every crevice of Britain's working landscape. Indeed, there are now more than eighty different well-being providers in England all suggesting that their services will deliver greater workplace happiness and (of course) productivity.

Today, once we have passed the personality tests that guard the gates to employment, the well-being movement awaits us on the other side, teaching us how to understand, frame and manage any difficult workplace emotions in ways that are having, as we will see, significant and far-reaching effects.

On 19 February 2018, a university lecturer called Malcolm Anderson woke at 4.40 a.m. as usual, and made the 56-mile trip to his office at the University of Cardiff. Before the early rush of students began, he climbed the empty stairway that wound languidly to the top of the university's library. Once there, he opened a large window, climbed precariously onto the ledge and threw himself a hundred feet to the ground below. Moments later, a horrified cleaner noticed the crumpled heap and dashed to his aid. 'Help me, help me,' Malcolm managed to groan before finally losing consciousness. He died later that morning in hospital, leaving behind his wife and three children.

Some weeks after his death, his suicide note, found in a locked drawer in his office, was finally made public. Malcolm had said that he could no longer cope with his crushing workload; the pressure had become too much and he could find no other way out. For weeks and months he had been suffering in private agony, having far more work than anyone could handle, yet no one seemed able to intervene in the way he needed. He had complained to management on a number of occasions about his work allocation, but said he had always received the same unhelpful response.

When I spoke to a lecturer at the university about Malcolm's suicide, he was clearly emotional: 'The whole event illustrates some very serious problems. I mean, the tragic irony of the suicide note was that it was published just as the university was in the middle of its "well-being fortnight", a programme designed to improve the mental health of staff and students and safeguard against these kinds of dreadful events. But the well-being fortnight didn't encourage people to discuss workload or any more substantial matters, neither to come up with meaningful solutions. It was all about, you know, come on a free excursion! Or go on a bike ride, because cycling is good for your health and well-being! There were no substantial or structural changes being offered as viable solutions - the kind of changes obviously Malcolm needed.'

Had Malcolm Anderson come into contact with this expanding well-being movement, what precisely would he have learnt? And would what he learnt have prevented the events leading to his death?

To address this question, allow me to introduce you to one of the largest and most successful workplace well-being providers of them all: Mental Health First Aid - or MHFA for It was first launched in England in 2007 under the auspices of the UK Department of Health, and now operates in 24 countries worldwide. In essence, MHFA's global mission is to create an international army of what it calls 'mental health first-aiders'. Essentially, these are the go-to colleagues in your office who have been trained by MHFA, over a one- or two-day course, to 'identify, understand and help a person who may be developing a mental health issue' in the

Since 2007, MHFA has trained nearly half a million 'first-aiders' in England (with over 70,000 being trained in 2019 alone). These now operate in a diverse array of workplaces right across the country. This rocketing uptake in MHFA's services has been helped by its claim to address worsening mental health at work and the billions it costs employers each By successfully marketing itself as a service that will increase employee productivity and loyalty, while reducing absenteeism and costly sick leave, MHFA relies upon a very simple logic designed to be attractive to the modern employer: any purchase of its services will be far outweighed by the well-being benefits (financial and otherwise) those services will promote.

In June 2019, with this marketing rhetoric in hand, I had little difficulty convincing my university HR department to fork out the £200 one-day training fee required to allow me to join the growing army of mental health first-aiders being trained across the UK. After some initial email exchanges with MHFA, a week later I was sitting with twelve other attendees in a small conference room in west London, where over the next seven hours we would learn the rudiments of what being a mental health first-aider was all about. Over a steady stream of PowerPoint slides, Morgan, our designated MHFA trainer, would inform us what mental illness actually was, how to spot its emergence in colleagues, when and how to step in to help, and to whom to refer fellow workers when we believed they had become ill. If this all felt like a little bit too much to master in a mere seven hours, well, never fear, we could always rely on the free MHFA manual that was included in the fee, where every pertinent concern and FAQ would be clearly addressed.

During one of our breakout discussions, I quietly slipped away from my group of chatty, coffee-sipping attendees and approached our instructor to ask a few questions in private. 'Thanks very much for this morning's presentation, Morgan, but something does kind of worry me,' I said after a few opening pleasantries. 'It seems that MHFA is using the medical language of "illness" and "disorder" in a very loose fashion, since many of the problems your slides describe as illnesses might be better read in non-clinical ways.'

To illustrate, I then recalled to him the case study our group had just discussed, concerning a middle-aged woman called Louise. Louise had worked for a company for eight years and had always performed well during that time. But in a recent appraisal she had said she was sleeping poorly, was finding it hard to concentrate at work and was feeling low and tearful. Despite our group learning that her workload had recently increased, they appeared unconcerned by the relevance of this, or anything else going on at work. Instead they agreed that Louise was displaying the classic signs of depression and might therefore need some professional help.

This emphasis on veering away from discussing what had happened to Louise by instead considering what was wrong with her (with a view to recommending what support she should seek) is very much at the heart of MHFA's approach. For example, while it does recognise that for some people in distress 'some reasonable workplace adjustments may be necessary', it is clear that first-aiders are not being trained to think about how to facilitate such adjustments. Rather, they are being asked to direct the people they have identified as suffering towards seeking 'appropriate professional help' such as 'medication, counselling or psychological therapy' - help that will enable them to recover more quickly and so return to their working demands. If people do not respond positively to these suggestions, first-aiders are asked to 'identify any barriers and reluctance a person may experience about accessing treatment' so that such barriers can be removed.

'What concerns me about all this,' I noted to Morgan, 'is that the general thrust of MHFA training is not about encouraging or empowering us to challenge managers and the organisational culture of our workplaces, but is rather about asking us to manoeuvre people towards mental health services that generally don't explore these things, and that invariably end up medicalising our distress and treating it accordingly - as a problem rooted in self rather than environment.'

Morgan appeared a little taken aback, before responding curtly: 'We don't make up the rules. We just outline the known symptoms of mental illness and teach you how to recognise them so you can refer people for professional support if needed.' To be fair, he was indeed correct. MHFA doesn't make up the rules: it simply teaches first-aiders how to play by them. But it is also true that the organisation doesn't question these rules either. You could even say that it advocates them, despite the fact that if we start uncritically advocating medical understandings of employee distress, other serious questions must follow: what happens to the idea that our environment, social circumstances or our jobs may be responsible for our misery? And what about the fact that more and more people find their work dissatisfying or meaningless; would this not affect their mental health? By not even mentioning these things, is MHFA not simply colluding with - or even worse, becoming an ambassador for - the uncritical medicalisation, and thus depoliticisation, of widespread worker distress?

Morgan and I continued talking until the end of the break, at which point we agreed to resume later. While I did not get to talk to him privately again (he now seemed to be avoiding me), I did manage to corral a couple of fellow first-aiders during lunch and asked whether they shared any of my concerns. David, head of human relations at a mid-sized London firm, was buoyant: 'It's great that courses like these exist - when I started working, it was all stiff upper lip in the office. This helps to change that, I think.' I agreed that the stiff-upper-lip culture was silly and harmful, but asked what happened to people once they did open up. Were they being asked to frame their problems in useful ways? Should first-aiders like us really be advising people to consult their GPs?

'What's wrong with that?' asked David. 'Surely that's where they'll get the help they need?'

'Well, not if their problems are situational or social or caused by work itself,' I answered. 'How can a GP possibly resolve issues like that, especially in a mere five-minute consultation? The fact is that they can't, and what's more, they are not trained to do so - and so instead, you are likely to be given a prescription, which shifts the emphasis towards something within you that is now being corrected rather than something within the workplace.' David and I enjoyed going back and forth a few more times, until his phone started buzzing, at which point I approached Jayne.

Jayne, it turned out, was the only other researcher on the course. She worked as a statistician at the University of Southampton, crunching demographical data for primary care services. 'I am here because there were quite a lot of mental health crises at work last year. As I showed interest in some of these issues, the department nominated me to come along.'

I asked her for her impressions of the course so far. 'Well, some of the research patter is a little bit questionable,' she responded, 'especially the stuff on outcomes - whether what MHFA offers has any positive effect on the workplace. I couldn't help notice,' she continued, 'that there was nothing at all on whether mental health first-aiders actually benefit co-workers or the company itself.'

She was right. The research on this matter was entirely absent. The MHFA website only cites four pieces of research, none of which address whether MHFA services actually improve employees' mental health and deliver the raised productivity and cost savings their marketing suggests. Instead, the research merely assesses whether first-aiders feel more knowledgeable and confident about managing mental health issues once their training is complete. So, despite hundreds of thousands of people in England training in MHFA, and hundreds of millions of pounds being spent on these courses globally, there is actually no evidence whatsoever that MHFA services benefit anyone other than the first-aiders themselves.

This absence of supportive evidence is not just true for MHFA, but for a burgeoning number of other well-being providers operating across the country today. When the UK government's Public Health England commissioned the first major review of these well-being programmes, not one was able to provide evidence showing that they directly improved worker productivity, lessened absenteeism or raised staff well-being. In fact, where organisations provided evidence on mental health outcomes, only one, a mindfulness-based online resource, could prove that it reduced stress and anxiety. The fact that this mindfulness resource was not actually a workplace programme, however, left me bemused as to why it had been included in the review at all.

Given that the research into these well-being programmes does not appear to support their implied claims, you'd expect this government-commissioned study to offer some strong words of caution about them. But that is not what we get. Rather, we hear words of praise and optimism: 'This study provides insight into a complex landscape with many levels of objectives and stakeholders. The workplace wellbeing sector appears vibrant but is still maturing in its ability to provide strong evidence for health and wellbeing

Would the study have been so generous (and would the services have been so popular with employers) if these workplace programmes encouraged employees to reflect critically on the conditions of their working life? Imagine asking a line manager to pay for a well-being course that tries to raise awareness of the various ways in which modern work can make you feel miserable and hopeless. Imagine their paying for a course that teaches that the growing crisis of worker distress has less to do with an epidemic of mental illness than with an epidemic of worker dissatisfaction and disengagement brought about by a host of factors, from flatlining wages to rising wage inequality; from the increase of short-termism in the employment market to longer working hours; from the growing pressure for dual-working households to the erosion of unionised working protections; from lower job security to the rapid expansion of the service sector.

The fact that well-being programmes such as MHFA completely veer away from any of these thorny social concerns is perfectly understandable from the standpoint of their own market ambitions. To sell their wares effectively they have to be attractive to their customers: the companies and organisations that pay for them. And what is more attractive than services that relocate responsibility for employee distress away from the organisational and social conditions of work itself and towards the more private structures of self. The whole business model of workplace mental health consultancies, in other words, fundamentally rests on a message that organisations will happily pay for: one that favours back-to-work policies and exonerates working conditions, while at the same time enabling organisations (and the government that helps fund these programmes) to declare sanctimoniously that they are tackling poor mental health.

In 2011, the Canadian Mental Health Association posted a short animation on its website that quickly went viral. A six-year-old girl narrates the film, which relays a procession of pictures that she has drawn. The first picture is of her and her father smiling and hugging as they play ball in the garden - the sun shines brightly in the background and a big pink flower is in bloom. Over the picture the little girl narrates: 'My daddy is the bestest daddy in the world. We play, laugh and have lots of fun, before he goes to

As soon as the girl says the word 'work', a gloom descends. The next picture shows her father, now very sad, leaving for work in his car, with dark clouds brooding overhead and a red tear rolling down his cheek. There then follows a picture of her with a very sad face, holding a drooping teddy. She narrates in a downcast voice: 'When my daddy comes home, he looks very tired and sad. I wish my bear could make my daddy feel happy again.' Her final picture shows her father sitting at his desk, head in hands, alone at the end of the day.

While this film is indeed very touching, that alone cannot account for why it enjoyed such wide impact. Along with packing a powerful emotional punch, it does something else extremely well: it leaves the nature and causes of her father's unhappiness at work purposely vague, which makes it easier for almost anyone who feels miserable at work to project their own experiences onto the film. This way, the narrative becomes very personal, speaking to anyone experiencing discontent at work for whatever reason. Once the film has built this personal connection with the widest possible audience, its webpage then invites you to consider the solutions for your own work distress. The first arrives in the form of an online survey devised to help you identify 'where your level of mental fitness could be improved to help you cope with all of life's up and downs'. Its thirty questions assess your levels of individual resilience, flexibility, ability to enjoy life and self-actualisation. Once filled in, the survey's algorithms set about calculating what personal qualities you should aspire to develop or improve in order to acquire such mental fitness. The next test - a work/life balance quiz - claims to be able to tell you accurately whether you are dedicating sufficient time to friends, family, hobbies and outside interests. If not, some rebalancing will be necessary to bring life back into happy accord

While both tests seem harmless enough, their surreptitious message is far less innocent: your distress, they imply, is due to something gone awry within you or your own life that you have the freedom to put right. Perhaps you need to reboot your work/life balance, or to become more flexible, resilient or better at self-actualising. Without explicitly saying so, the central message is basically that you need to change, and change is in your own hands. Questions about the external causes of and solutions for your distress simply don't arise; nor do questions as to whether people actually have the time or financial freedom to change.

While most of us would like to spend more time with family and friends, surely reducing our working hours is a luxury that only few can afford. And while self-actualisation also sounds appealing enough, how viable is it for the 60 per cent whose leisure time will be largely spent recovering from jobs that leave them empty and exhausted? Sure, while developing more flexibility and resilience sounds compelling on the page, are these developments really going to improve your well-being or will they simply better adapt you to the kind of work that goes against your fundamental human desires and needs? The real world does not allow us to easily embrace the idealistic self-improvement strategies that these campaigns simplistically advocate; strategies that, despite any good intentions, are mostly impractical distractions from realities often best unseen.

This dominant theme of changing our selves rather than our relationship to the contexts in which we operate can be seen in a final example. It concerns a recent national initiative undertaken by the UK Advisory, Conciliation and Arbitration Service (ACAS) and largely funded by the government's Department for Business Innovation and Since its launch in 2015, a central focus of ACAS's Promote Positive Mental Health at Work campaign has been teaching managers across the country how to identify and manage mental distress or 'illness' in their employees. Like the ongoing MHFA campaign, ACAS agrees that if you can spot mental health problems in your workforce early on, you will spare yourself costly losses to employee productivity down the line. So how are managers advised to intervene in worker distress?

Firstly they are told not to think too much about wider social causes of distress in the workplace. After all, mental illnesses have 'many possible causes'. And while 'some of these causes may be related to workplace issues ... more often than not these [workplace issues] will compound existing medical or personal problems'. In other words, while workplace issues may be implicated in worker distress, they are rarely to blame, because there is some existing fault within you making these issues more impactful than they otherwise would be.

Managers are then told to be vigilant when trying to spot mental illness, as it is 'less conspicuous than physical illness' and also because employees 'may work very hard to disguise their symptoms'. Despite these barriers to detecting the mentally unwell, managers are informed that they should still be able to identify them if they work hard to 'take note of what you see as you walk around or in team meetings'; if they familiarise themselves with the signs of illness, so to speak. So what are the classic signs of 'mental illness' that managers should try to identify in their colleagues? Well, fortunately, ACAS provides a list:

*Uncommunicative or moody behaviour

*Poor performance

*Poor timekeeping

*Poor decision-making

*Lack of energy

*An increase in unexplained absences or sick leave

Given the countless understandable reasons why someone could manifest any of these issues at work, it is odd that ACAS provides no rationale for why these signs should be reframed as so-called symptoms of illness. This is all the more surprising since none of the signs actually map onto any official diagnostic criteria for depression or anxiety (as problematic as these criteria can and all of them could be interpreted in manifold non-medical ways - as classic signs of worker dissatisfaction and disengagement, for starters.

After managers are taught how to medicalise normal human behaviours, they are then asked to 'engage with the problem'. This involves 'developing a rapport with the employee' to get at a 'deeper understanding of their problem', which will enable them to identify 'the best coping strategies' for that particular person. While such strategies may include superficially tweaking the immediate working environment (helping with desk swaps, advising walks in the park and the use of to-do lists), if these tweaks don't work, you are advised to refer your colleagues for counselling, employee assistance or specialist clinical services such as the kind of psychological therapies we will consider in the next chapter - therapies, as we will see, that are designed to serve the task of getting people back to work with minimum fuss or

In short, when we inspect the expanding raft of workplace well-being interventions, we learn that MHFA is no outlier in the burgeoning mental health consultancy world. It is rather one typical example of a rapidly expanding social movement that is busy medicalising and reframing how we should understand and manage the pains of work in modern life.

Six months after Malcolm Anderson took his own life, academics at the University of Cardiff had had quite enough. Over five hundred of them now took direct action, highlighting their workplace grievances in a joint public statement. The university, by failing to tackle the deeper institutional and social roots of workplace distress, was purposely 'sticking its head in the sand', and the new mental health programme being championed as a solution was 'just an inadequate sticking As one Cardiff academic put it to me: 'These workplace programmes are simply a distraction - they are about depoliticising the problems of work, which have structural and organisational roots. In fact, you could even say it is more insidious than that - they are really about trying to control the way we are allowed to talk about our distress, shaping it in a way that always tries to exonerate the organisation.'

Of course, many advocates for these programmes would counter that they perform a vital public service by emphasising the links between work and emotional health, by suggesting that working too hard for too long can be harmful and by insisting employers and managers should be sympathetic to employees in emotional need. When and where their messages help people in distress, these advocates do have an important point. But what many Cardiff academics were now realising was the extent to which such programmes are also political tools that subtly redirect our discourse away from challenging the major problems afflicting working life (especially with regard to how it has evolved over the last thirty years) and towards thinking of ourselves as somehow at fault, and in need of services that may remedy our afflictions (at a cost).

While many academics therefore see things critically, the growing popularity of these programmes suggests that most of us probably do not. And perhaps we do not for understandable reasons. Such programmes, after all, target managers and employees, who are often struggling, tired and overworked; who often lack the time, job security and in some cases the critical resources needed to challenge the status quo. They also overlook the widespread meaninglessness of much modern work, while evading critical reflection on the economics that shape the employment market. By subtly accepting that increased worker output and productivity, rather than the nurturance of wider human potential, should be the primary goal of their interventions, these programmes give simple and attractive solutions to problems that have far deeper and more complicated roots, and provide moral cover to both corporations and politicians who claim, in good faith, that they take mental health seriously via the services and funding they

Given the evident benefits such consultancies bring to organisations, it is little wonder that they continue to thrive despite there being no evidence for their effectiveness - no research showing they make people less distressed and more productive at work. But perhaps, from the standpoint of company and organisational interests, being effective is not really the point. After all, when push comes to shove, these programmes still deliver significant value for money, by largely helping to control the narrative about what causes workplace distress. By removing difficult work experiences from the domain of public discussion, and placing them into the private domain of the consultancy room, the negative effects of modern work can be medicalised, individualised and depoliticised and thus more safely, quietly and confidentially diffused.

In October 2019, after attending a meeting in London at the Royal College of Psychiatrists, I noticed a large placard bolted to the wall behind the main reception desk as I left the building. Across the placard, emblazoned in bright green letters, were the words: Mental Health First MHFA had somehow managed to manoeuvre its way into the heart of the British psychiatric establishment. The placard's prominent positioning in the main lobby symbolised the college's seal of approval and the fact that certain allegiances had already crystallised. After all, the medicalisation of common forms of emotional distress is central to what both organisations do, with both promoting drugs like antidepressants for evidently social and psychological problems (even if this only happens by implication with MHFA). Whatever your view on the spread of these consultancies, the placard illustrates that they are winning mainstream support and have ideologically aligned with the biomedical thrust of our mental health system as it has developed over the last few decades - a system to which they send dissatisfied and disengaged workers for medical and psychological interventions. As to how these interventions operate, well, that will be the topic of the next chapter.

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Chapter 8: Chapter 3: The New Dissatisfactions of Modern Work - Sedated: How Modern Capitalism Created our Mental Health Crisis

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A provocative and shocking look at how western society is misunderstanding and mistreating mental illness. Perfect for fans of Empire of Pain and Dope Sick. In Britain alone, more than 20% of the adult population take a psychiatric drug in any one year.

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Georgia's recommended reading - chapter from 'Insane Medicine' by Sami Timimi

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Georgia's recommended reading - chapter from 'Insane Medicine' by Sami Timimi

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Sami Timimi is amazing! He is a child psychiatrist and psychotherapist who describes himself as a 'critical psychiatrist' in that he critiques the way psychiatry has had harmful effects on people.

The chapter starts with a quiz - you can just skip this and go straight to the main body - subtitled: 'The medical model of mental health is finished'

Here he completely dismantles the diagnostic medical model and argues that continuing to prop up this model will never lead to the solutions we need.

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Insane Medicine, Chapter 1: The Medical Model of Mental Illness Is Finished

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The psychiatric ideology turns us into potential patients, alienating us from ordinary and understandable emotions.

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Challenging mental health stigma and discrimination from SeeMe

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Challenging mental health stigma and discrimination from SeeMe

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Challenging mental health stigma and discrimination. Notes for discussion.

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Challenging mental health stigma and discrimination. Notes for discussion.

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Challenging mental health stigma and discrimination

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Don't panic!

This is something I've used many times in business and was part of my studies on "Coaching and Mentoring" at Harvard. It's works just like it sounds. This should mirror the plans we have but often can identify components that are missing.

Many thanks,

Paul

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Claire Gibson:

ClaireG@healthymindscalderdale.co.uk

Jonny:

Jonny@healthymindscalderdale.co.uk

Georgia:

georgia@healthymindscalderdale.co.uk

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From Jonny:

Attitudes to MH survey (attached)

In here you will find the statements they used in their survey - it could be worth testing these out with the group to see if people feel they are relevant / useful.

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Information about the Time To Change campaign

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Information about the Time To Change campaign

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A ground breaking campaign that changed the mental health landscape

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Today we say goodbye to Time to Change - the 15-year long anti-stigma campaign on mental health, which has transformed the way we think about mental health in England. Brian Dow, Deputy CEO of Rethink Mental Illness reflects on the amazing success of the campaign and how it started the nation talking.
The truth is that 15 years ago the levels of discrimination faced by people living with mental health problems were utterly shocking. So when the two charities that founded Time to Change - Rethink Mental Illness and Mind - got together to create a programme which was designed to challenge negative attitudes around mental health it was a leap of faith and ambition. It was this ambition we took to what would become the campaign's three funders: The Big Lottery Fund, Comic Relief and the government.

In the following period, Time to Change developed its groundbreaking social contact programme. This was built on the premise that one in four of us experience a mental health problem at any given time in an average year. It became the bedrock of a movement galvanising literally hundreds of thousands of people to share their experiences and convey a remarkably simple message. One that has become so standard and accepted that it is almost a cliché - namely that it is ok not to be ok.

That people such as myself can go into a large organisation now and state that view, or the truism that we all have mental health, and not be faced by a sea of perplexity or disagreement is only possible because of the relentless push for change. For a long period very much against the grain of public opinion.

Schools, employers and communities

The campaign also encompassed tailored programmes in schools and in the broader community as well as in the workplace. The fact that has been the inspiration for many organisations to enter the fray is a reliable sign of its success. It was the campaign which put the rocket fuel under so many local and national organisations.

"It created the confidence among the public to talk about mental health, and arguably it helped celebrities both in the UK and across the world open up about their own mental health challenges."

All of that has led to attitude change on a wide scale. When the campaign first started, it was routine for people to openly acknowledge they would not be prepared to have someone who was mentally unwell in their social circle, much less to work or even live next door to someone experiencing a serious mental health illness. Now, it seems barely a day goes by without a high-profile person speaking openly about their mental health problems.

Passing on the baton

There's an old saw in the charity world that you should work really hard to put yourself out of business. In these most straitened of times that might sound like a fairly apocalyptic rule by which to live but it speaks to a wider point that when you start a career in the voluntary sector you are usually entering a cause which requires improving or alternatively eliminating.

"Intuitively it somehow does not feel right for Time to Change to be closing while we are in the middle of a global pandemic which is having a population level impact on the nation's mental health like virtually nothing else has in the last 80 years."

But the work, campaigning and change will carry on without us. Many new organisations are in this terrain and some have specialism in all sorts of aspects around mental health. Local groups who are deeply embedded in their communities. Local groups who are deeply embedded in their communities. Organisations that will help take on the anti-stigma movement within ethnic minority communities, who understand at a deep level the racism and discrimination that have such a profound impact on their mental health. Something that has come into even sharper focus since the murder of George Floyd last year.

Sharing evidence and knowledge

Time to Change also has a significant body of data and evidence behind it. Both Rethink Mental Illness and Mind were clear from the start that building up robust evidence and knowledge would help continually shape how we tackle stigma and discrimination.

That deep understanding of what works is a legacy that can be shared nationally and globally. Both founding organisations are committed to sharing this openly with any individual or organisation that can use it to help target its interventions.

So although the heart is heavy, at the same time there is a reassuring sense that others will take on the baton and run with it.
Time to Change may be ending but everyone who worked on it and in particular its two Directors, Sue Baker and Jo Loughran as well as its army of supporters, should feel a huge sense of pride. We said it was Time to Change, and as it turns out, it was.
"Needless to say both Rethink Mental illness and Mind remain deeply committed to the broader issue of stigma and discrimination and will keep working collaboratively and individually to tackle it wherever it rears its head. Speaking truth to power, wherever it is held."

The tide may have changed and with it all boats may have risen, but people experiencing severe mental illness such as schizophrenia still routinely have terrible outcomes and face profound discrimination and stigma daily.

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A ground breaking campaign that changed the mental health landscape

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We're saying goodbye to Time to Change - the 15-year long anti-stigma campaign on mental health, which has transformed the way we think about mental health in England. Brian Dow, Deputy CEO of Rethink Mental Illness reflects on the amazing success of the campaign and how it started the nation talking.

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Suicide Prevention language poster example

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Suicide Prevention language poster example

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From Jonny:

We talked about a guide for appropriate language:

As well as the attached creating hope through language, there is this:

Language-guide-for-talking-about-suicide.pdf (shiningalightonsuicide.org.uk)

It would be useful to circulate this re. suicide anyway, but the idea was to develop a similar guide around MH in general - say this instead of that sort of idea.

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E-learning opportunities here: https://www.seemescotland.org/workplace/employers/learning-and-events/e-learning

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6/10/23 - Message from Paul:

I’ve been doing a bit of research over the last few days and I stumbled across a website for “SeeMe Scotland” They have an excellent section on “Stigma and Discrimination”. I can’t find a similar site in England.

Within the website they have a section called “Tools for Everyone” that is useful information and techniques for speaking about mental health.

They also have a report “The Scottish Mental Illness Stigma Study” which is 200+ pages which I will study in due course.

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