Schizophrenia: the most misunderstood mental illness?

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diagnosis, discrimination, fear, help, media, mental health issues, paranoia, psychosis, recovery, schizophrenia, shame, silence, stereotypes, stigma

Schizophrenia: the most misunderstood mental illness?

Let’s face it, when most people think about schizophrenia, those thoughts don’t tend to be overly positive. That’s not just a hunch. When my charity, Rethink Mental Illness, Googled the phrase ‘schizophrenics should…’ when researching a potential campaign, we were so distressed by the results, we decided to drop the idea completely. I won’t go into details, but what we found confirmed our worst suspicions.

Schizophrenia affects over 220,000 people in England and is possibly the most stigmatised and misunderstood of all mental illnesses. While mental health stigma is decreasing overall, thanks in large part to the Time to Change anti stigma campaign which we run with Mind, people with schizophrenia are still feared and demonised.

Over 60 per cent of people with mental health problems say the stigma and discrimination they face is so bad, that it’s worse than the symptoms of the illness itself. Stigma ruins lives. It means people end up suffering alone, afraid to tell friends, family and colleagues about what they’re going through. This silence encourages feelings of shame and can ultimately deter people from getting help.

Someone who knows first hand how damaging this stigma can be is 33 year-old Erica Camus*, who was sacked from her job as a university lecturer, after her bosses found out about her schizophrenia diagnosis, which she’d kept hidden from them.

Erica was completely stunned. “It was an awful feeling. The dean said that if I’d been open about my illness at the start, I’d have still got the job. But I don’t believe him. To me, it was blatant discrimination.”

She says that since then, she’s become even more cautious about being open. “I’ve discussed it with lots of people who’re in a similar position, but I still don’t know what the best way is. My strategy now is to avoid telling people unless it’s comes up, although it can be very hard to keep under wraps.”

Dr Joseph Hayes, Clinical fellow in Psychiatry at UCL says negative perceptions of schizophrenia can have a direct impact on patients. “Some people definitely do internalise the shame associated with it. For someone already suffering from paranoia, to feel that people around you perceive you as strange or dangerous can compound things.

“I think part of the problem is that most people who have never experienced psychosis, find it hard to imagine what it’s like. Most of us can relate to depression and anxiety, but a lot of us struggle to empathise with people affected by schizophrenia.”

Another problem is that when schizophrenia is mentioned in the media or portrayed on screen, it’s almost always linked to violence. We see press headlines about ‘schizo’ murderers and fictional characters in film or on TV are often no better. Too often, characters with mental illness are the sinister baddies waiting in the shadows, they’re the ones you’re supposed to be frightened of, not empathise with. This is particularly worrying in light of research by Time to Change, which found that people develop their understanding of mental illness from films, more than any other type of media.

These skewed representations of mental illness have created a false association between schizophrenia and violence in the public imagination. In reality, violence is not a symptom of the illness and those affected are much more likely to be the victim of a crime than the perpetrator.

We never hear from the silent majority, who are quietly getting on with their lives and pose no threat to anyone. We also never hear about people who are able to manage their symptoms and live normal and happy lives.

That’s why working on the Finding Mike campaign, in which mental health campaigner Jonny Benjamin set up a nationwide search to find the stranger who talked him out of taking his own life on Waterloo bridge, was such an incredible experience. Jonny, who has schizophrenia, wanted to thank the man who had saved him and tell him how much his life had changed for the better since that day.

The search captured the public imagination in a way we never could have predicted. Soon #Findmike was trending all over the world and Jonny was making headlines. For me, the best thing about it was seeing a media story about someone with schizophrenia that wasn’t linked to violence and contained a message of hope and recovery. Jonny is living proof that things can get better, no matter how bleak they may seem. This is all too rare.

As the campaign grew bigger by the day, I accompanied Jonny on an endless trail of media interviews. What I found most fascinating about this process was how so many of the journalists and presenters we met, were visibly shocked that this young, handsome, articulate and all-round lovely man in front of them, could possibly have schizophrenia.

Several told Jonny that he ‘didn’t look like a schizophrenic’. One admitted that his mental image of someone with schizophrenia was ‘a man running about with an axe’. It was especially worrying to hear this from journalists, the very people who help shape public understanding of mental illness.

Many of the journalists also suggested that through the campaign, Jonny has become a kind of ‘poster boy’ for schizophrenia and in a way, I think he has.

Jonny has mixed feelings about the label. “I hope that by going public with my story, I’ve got the message out there that it is possible to live with schizophrenia and manage it. It’s not easy, it’s an ongoing battle, but it is possible. But I’m aware that I’m one of the lucky ones. I’ve been given access to the tools I need like CBT, but that’s not most people’s experience. Because of our underfunded mental health system, most people don’t get that kind of support. I can’t possibly represent everyone affected, but I hope I’ve challenged some stereotypes.”

As Jonny rightly says, one person cannot possibly represent such a diverse group of people. Schizophrenia is a very broad diagnosis and each individual experience of the illness is unique. Some people will have one or two episodes and go on make a full recovery, while others will live with the illness for the rest of their lives. Some people are able to work and be independent and others will need a lot of support. Some people reject the diagnosis altogether.

What we really need is a much more varied and nuanced depiction of mental illness in the media that reflects the true diversity of people’s experiences.

What I hope Jonny has managed to do is start a new conversation about schizophrenia. I hope he has made people think twice about their preconceptions of ‘schizophrenics’. And most importantly, I hope he has helped pave the way for many more ‘poster boys’ and girls to have their voices heard too.

For more information, visit Rethink Mental Illness

*Name has been changed

 

Britons show Victorian attitudes to epilepsy as children who suffer from the condition are accused of being ‘possessed’

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Bullying, Children, discrimination, epilepsy, friends, possession, prejudice, seizure, teachers

Britons show Victorian attitudes to epilepsy as children who suffer from the condition are accused of being ‘possessed’

One in five children who suffer with epilepsy has been accused of being “possessed” after having a seizure, according to shocking new research.

Britons’ Victorian attitudes to the condition are exposed in a report published by the charity Young Epilepsy.

It finds that over three quarters of people of all ages have experienced discrimination as a result of their epilepsy. More than 40 per cent of children have experienced discrimination or exclusion from their peers, and almost a third have faced discrimination from teachers.

In addition, two fifths have faced discrimination from strangers, and 8 per cent by doctors and medical professionals, according to polling for Young Epilepsy by Opinion Matters.

Negative reactions from others after a child suffers a seizure include being told being told that epilepsy is contagious, which happened to a third of affected children, and being asked if they could speak to spirits, which occurred to 18 per cent.

David Ford, chief executive of Young Epilepsy, said: “It’s a level of prejudice more akin to 1913 than 2013. We knew there was some discrimination but we had no idea it was on this scale.”

Conservative MP Laura Sandys said: “I’m epileptic and I know from personal experience that this is what people think.

“There’s been a sea-change in people’s perceptions of most disabilities, but epilepsy still seems to be seen as something you keep quiet about; it still hasn’t shaken off that perception that you’re somehow possessed by the devil or demonised.”

Ms Sandys, who is chair of the All-Party-Parliamentary Group on Epilepsy, said: “There have only been two MPs who have declared their epilepsy, but statistically there should be another four.”

Experts are concerned that this prejudice means that children with epilepsy are less inclined to be open and discuss their condition, something which could have serious health implications.

This guardedness continues into later life, with 55 per cent of those adults who were questioned in the survey saying that they never disclose their epilepsy to new people because they fear a negative reaction from them.

Professor Helen Cross, Prince of Wales chair of childhood epilepsy at University College London and Great Ormond Street Hospital, said: “These high levels of prejudice have a huge impact on how children can manage their condition. If you’re worried about being bullied then you don’t want to talk to people about it, which means you don’t have buddies who know what to do if you have a seizure.”

She added: “Epilepsy is as common as diabetes, and in childhood it’s more common, but while I bet every schoolchild can name someone they know with diabetes, I’m sure that’s not the case with epilepsy.”

Case study: Elliot Harden, 11

Julie Harden from Oxted, Surrey, is mother of Elliot, 11, who suffers from a life threatening form of complex epilepsy

“Some people are really quite nasty about epilepsy. In conversations Elliot has been called ‘a retard’, ‘mad’, ‘not right’ and ‘that scary boy’. Even coming into my house people jump back from him as if they’re worried they’re going to be attacked.

I’ve got friends who won’t come round to our house with their children because they’re scared of what they might see. One time my other son Cameron, who is 8, was playing with other children upstairs. Elliot came up to see them and the other children ran away downstairs.

One of my neighbours even bangs on the wall saying ‘f-ing this and that’ when Elliot is having a seizure and fighting for his life. Another neighbour ran out of the house when he had a seizure.

Parkinson’s sufferers ‘face abuse’ because of symptoms

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abuse, discrimination, drunkenness, Parkinson's disease, prejudice, symptoms

Parkinson’s sufferers ‘face abuse’ because of symptoms

Parkinson’s disease sufferers are being subjected to “intolerable levels of prejudice”, a charity has warned, after it was found that two in five of those afflicted with the disease have experienced discrimination because of their symptoms.

Parkinson’s UK said that 41 per cent of sufferers say they have been discriminated against because they suffer from the disease.

And 8 per cent said they have experienced hostility or have been verbally abused in public because of symptoms of the neurological condition , according to a new poll conducted by Parkinson’s UK on 2,900 sufferers.

The degenerative disease affects 127,000 people across the UK, and symptoms can include shaking, slowness of movement and rigidity.

The research, undertaken to highlight Parkinson’s Awareness Week, also found that one in five Parkinson’s sufferers have had their symptoms mistaken for drunkenness.

And almost a quarter of sufferers admitted they avoid going out at busy times of the day because they are wary of people’s reactions to them.

Steve Ford, chief executive at Parkinson’s UK, said: “Our research confirms that far too many people with Parkinson’s are having to battle against intolerable levels of prejudice.

“Life with Parkinson’s can be challenging enough, but when that is coupled with feeling scared to even go out in public for fear of freezing in a busy queue and being tutted or stared at – as over half the people we spoke to do – life can feel incredibly cruel.

“Time and again people with Parkinson’s have to fight against the old stereotype that the condition is just a tremor. This basic misunderstanding has sentenced people with Parkinson’s to a life of hurtful comments, being refused service in shops and even being shouted at in the street all because people have mistaken their speech or movement problems – a common symptom of the condition – for drunkenness.”

Sufferer Ruth Martin, a mother of two from Holmfirth, west Yorkshire, said that since her diagnosis in 2008 she has struggled to deal with how people react to her condition.

The 41-year-old said: “I’ve experienced all sorts of discrimination since I’ve had Parkinson’s, but one incident really stands out. I was having a bad day and was waiting in a queue in a pharmacy. The man standing behind me with his wife said really loudly to her “just stand back a bit love, the woman in front has been drinking”.

“I felt like crying but even so I told him that I had Parkinson’s. The whole shop was listening and there was part of me that wanted to scream out – I felt like I couldn’t go anywhere.

“People have been very confrontational towards me, and I have even been followed round a supermarket by a security guard who obviously thought I was acting suspiciously. I just wish that if people saw others staggering or struggling that it would cross their minds to wonder if they’ve got Parkinson’s.”

MPs get mental health clinic after rise in cases of depression and anxiety

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anxiety, Depression, discrimination, doctors, mental health issues, MPs, politicians, stigma, treatment

MPs get mental health clinic after rise in cases of depression and anxiety

MPs will be able to access a mental health clinic within Parliament which is being set up to deal with the rising number of politicians approaching doctors about depression and anxiety.

Officials have approved £25,000-a-year funding for the specialist treatment centre which will run alongside conventional GP services.

MPs say the stigma still attached to mental illness means it is hard for them to approach their family doctors about such problems.

Doctors in the House of Commons have seen an increase in number of MPs coming to them with mental health difficulties, a sign they are more willing to admit to problems which were previously repressed.

On Monday Parliament gave final approval to the Mental Health (Discrimination) Bill, which scraps a law that says MPs automatically lose their seats if they have been sectioned for more than six months, as well as a rule allowing company directors to be removed because of mental illness.

However, MPs say discrimination against mental illness means it is much harder for them to talk to local GPs about such problems than it would be for physical ailments.

The body which oversees MPs’ working conditions has therefore agreed to fund treatment such as cognitive behavioural therapy from specialists at St Thomas’s hospital.

A consultant psychiatrist is available at Westminster to diagnose mental health problems and referral for in-patient treatment will also be available, the Commons Members’ Estimate Committee decided.

Job applicants with schizophrenia facing ‘discrimination’

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carers, discrimination, employment, recovery, remission, schizophrenia, stigma, workplace

Job applicants with schizophrenia facing ‘discrimination’

Tens of thousands of people with schizophrenia are being denied the chance to work because of “severe discrimination”, a report has found.

Only eight per cent of people with schizophrenia are in paid employment, compared with 71 per cent of the general population, although many more would like a job, a report by the Work Foundation says.

Seven out of 10 people with schizophrenia feel that they experience discrimination because of their condition. The report blames a lack of understanding, stigma, fear and discrimination towards people with schizophrenia and calls for urgent government action to prioritise work as part of the recovery for those with mental illnesses.

People with schizophrenia in paid employment are over five times more likely to achieve remission from their condition than those who are unemployed or in unpaid employment, according to the report, Working with Schizophrenia.

Charles Walker, chairman of the all-party mental health group in the Commons, said: “For many people with the condition, having a job can mean a great deal, both economically and socially.

“We must ensure funding continues so that more people living with schizophrenia can access the workplace and carers can also return to work.”

Trafficking girls in India

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abuse, Bangladesh, discrimination, girls, India, infanticide, Nepal, rape, Sexual Violence, stigma, support, Trafficking, young people

The BBC Radio 4 iplayer website currently has a podcast available on Trafficking girls in India

From the blurb:

In a major investigation, Natalia Antelava reports on the abduction of tens of thousands of young girls in India for forced marriages. Thousands more are sold as prostitutes and domestic servants. She follows the route of the traffickers, who take girls from destitute households in places like West Bengal to wealthier areas in Northern states, where a shortage of women is blamed by many on sex-selective abortions. It’s a problem the United Nations describes as of ‘genocidal proportions’. Natalia joins campaigners and police fighting the trade and hears the stories of the trafficked girls and from a trafficker himself.

Stigma of mental ill health is ‘worse than the illness’

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anxiety, barriers, Depression, discrimination, economy, employment, mental health issues, psychotherapy, recession, relationships, stigma, Therapy, treatment

Stigma of mental ill health is ‘worse than the illness’

It is the single biggest cause of disability in the Western world but many sufferers say the stigma attached to it is worse than the illness itself, according to researchers.

While celebrity sufferers who speak out about their depression are hailed as heroes, ordinary citizens are shunned, taunted and abused.

An international study of more than 1,000 sufferers in 35 countries has found that three quarters said they had been ostracised by other people leading them to avoid relationships, applying for jobs and contacting friends.

Discrimination is leading many to put off seeking treatment with a subsequent worsening of their condition.

Drugs and psychotherapy can help 60-80 per cent of people with depression but only half get treatment and only 10 per cent receive treatment that is effective – at the right dose, for long enough and with the right kind of therapy.

The international study published in The Lancet found that levels of discrimination were similar to those for schizophrenia revealed in a similar study three years ago.

Professor Graham Thornicroft, head of health service and population research at the Institute of Psychiatry said: “We have a major problem here. Non-disclosure is an extra barrier – it means people don’t seek treatment and don’t get help.”

While public confessions of depression by well known people including the tennis champion Serena Williams, the US actress Kirsten Dunst and chat-show host Stephen Fry were increasing, abuse of sufferers was also widespread.

The Norwegian Prime Minister, Kjell Bondevik, attracted worldwide approval when he relinquished power for three weeks to his deputy in 1998 while he recovered from an episode of depression. He was subsequently re-elected.

In contrast, Professor Thornicroft described the case of a woman who had dog faeces posted through her door because neighbours wanted her out and another in which police halted an interview with a man whose flat had been burgled when they learnt that he had been in psychiatric hospital.

“Our findings show discrimination is widespread and almost certainly acts as a barrier to an active social life and having a fair chance to get and keep a job,” he said.

The Government’s Time to Change campaign launched in 2008 aimed at reducing discrimination against people with mental illness had proved to have had a “modest but significant” impact, he added.

In a separate study, researchers have found that the 2008 economic crash led to a deterioration in the mental health of men – but not women.

Anxiety and depression increased markedly among men in the three years following the crash, but women escaped largely unscathed.

Rising unemployment and falling income are not to blame, the researchers say. Instead, job insecurity is thought to be the cause.

Mental ill health among men rose from 13.7 per cent in 2008 to 16.4 per cent in 2009 before falling back to 15.5 per cent in 2010, according to the study published in the journal BMJ Open.

Men derive much of their social status from their occupation and are still the main wage earners in most families. They are becoming more mentally unstable because of the fear of losing their jobs in the recession.

The authors from the Social and Public Health Sciences Unit in Glasgow, say that while women’s mental health appeared to change little in the period it may have deteriorated since due to job cuts in the public sector.

 

Life begins at 65: workers can now stay on if they want

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age, discrimination, employment, retirement

Life begins at 65: workers can now stay on if they want

For many people, retirement is something to look forward to. But for others, it is not. When Knud Moller, a former government statistician, was forced to leave the job he loved in 2007 simply because he had turned 65, it was a horrible blow.

Mr Moller had hoped to keep working at least until the next national census, which was four years away, in 2011. Unfortunately, he didn’t have a choice. The law required that he retire, and the Stoke native was forced out of his job.

“I felt very unhappy. You lose your professional dignity and you, in a sense, become nobody,” Mr Moller, now 70, said. “I felt very bitter. I have applied for many jobs since then but often don’t even get an acknowledgement of my application.”

From today, however, the forced retirement law is no more. The Default Retirement Age (DRA) – which allowed employers to force people to retire when they reached 65 – has been abolished and older workers will be able to choose when they stop working.

Charities and senior citizens’ groups have campaigned against the DRA since it was introduced as an anomaly of new age-equality regulations in October 2006, arguing it discriminated against workers because of their age.

The charity director general of Age UK, Michelle Mitchell, welcomed the end of the law as a “major milestone in the fight against age discrimination”.

“We hope that now it is illegal to force someone out of their job simply because they are 65 or over, it will make employers look beyond their staff’s date of birth, objectively assess their skills and contributions and trigger a more positive and realistic attitude to older people,” she said. She warned that people over 50 find it harder than any other group to get a job.

But there are 955,000 people over 65 currently in work, or nearly one in 10 of that age group. This figure has risen steadily in recent years. Aside from the financial incentive, many of those who have continued working do so because they enjoy the activity. Gary Wakefield, 68, from Battersea, London, has worked at B &Q since his former employers made him partially redundant at 62, arguing that he was too old to continue as a forklift driver.

“I have always been a busy person. I cannot see myself sitting in front of the TV. I have been married for 48 years but I think that if you see your wife 24/7 it doesn’t always work, so it’s nice that I can be away for four hours every day.”

Case study: ‘I like working. My life is much more fulfilling’

Jean Rumbold, 70, from Southampton, was forced to retire as a GP surgery receptionist aged 65 and also had to give up the Brownie pack she had run for the past 32 years. Today, she works as a medical records officer at a local hospital in the mornings and as a swimming teacher in the afternoons.

“I felt cheated because I was doing a job I absolutely loved and I could have carried on. But there was no way I was going to give up work. I just like working. I feel as though my life is more fulfilling because I work. I enjoy my leisure time when I’ve got it but I like to keep busy.

“I also like the extra money. I get a state pension and the money from my two jobs has enabled me to buy a new car, go to the theatre and know I do not have any money problems.

“My husband is disabled – he’s got severe osteoarthritis. I work to 12.30pm at the hospital then come home and see to him. I need that job to keep me sane. Watching TV all day would drive me round the twist. I just love teaching swimming – there is a real sense of achievement”.

Number of older people living with cancer ‘to treble’ by 2040

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Cancer, discrimination, older adults, support, treatment

Number of older people living with cancer ‘to treble’ by 2040

The number of older people living with cancer will more than treble by 2040, say experts, who warn of a “ticking timebomb” for society if the NHS and social care systems are not geared up to help them in time.

Macmillan Cancer Support says the number of over-65s who have received a cancer diagnosis will go up from 1.3 million in 2010 to 4.1 million in 2040.

Its estimates – based on research from Kings College London, which it funded – mean that nearly a quarter of all older people (23%) will be living with cancer within 30 years. At the moment, the figure is 13%.

The biggest increase, according to the study – published online by the British Journal of Cancer – will be in lung cancer in women, which is expected to more than double from 319 to 813 per 100,000 people. While the number of men smoking has declined markedly since the 1970s, women have not quit in the same numbers.

Professor Henrik Møller, one of the study’s authors at King’s College London, said: “The aim of this research is to provide long-term projections of cancer prevalence in the UK.

“The research shows that large increases can be expected in the oldest age groups in the coming decades and, with this, an increased demand upon health services,” he said.

Cancer is predominantly a disease of older age. More than 60% of people living with cancer are over the age of 65 and half are over 70. The numbers of older people with cancer are rising sharply because the population is living longer, but also because cancer rates are increasing and treatments are improving so that more patients are surviving for longer or are cured altogether.

But in spite of this, Macmillan argues that older people who are diagnosed do not always get the best care. Decisions about which treatments to give people are too often based on age, rather than on fitness, says the charity.

Older patients are less likely to have radical surgery or radiotherapy and some studies suggest that their survival is less likely because of it. Older people are also more likely to find it harder to recover after their treatment and more likely to feel abandoned by the health service than younger people.

Ciarán Devane, chief executive of Macmillan Cancer Support, said: “The care of older cancer patients is the ticking timebomb for society.

“These stark predictions should act as a warning to the NHS and social care providers of the problems ahead if older cancer patients are not offered the best treatment and support.

“We have a moral duty to give people the best chance of beating cancer, regardless of their age. For cancer survival to improve, older people must be given the right treatment at the correct level of intensity, together with the practical support to enable them to take it up.

“The barriers to older people getting treatment must be tackled. If we don’t get this right now, many older people will be dying unnecessarily from cancer in the future,” he said.

A Department of Health spokesperson said: “It’s good news that improvements in cancer treatment mean more people are surviving after cancer.

“We know more can be done to improve cancer care for older people, which is why we are working with Macmillan Cancer Support and Age UK on a £1m programme to ensure that older people’s needs are properly assessed and met.

“From 1 October 2012, it will be unlawful to discriminate in health and social care on the basis of age. Adults of all ages will benefit from better access to services, and for the first time people will have a legal right to redress from the courts if they are unjustifiably discriminated against because of their age.”

Mental health discrimination is coming from the top, not the public

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anxiety, discrimination, employment, government, mental health issues, stigma, suicide

2011:

Mental health discrimination is coming from the top, not the public

The government, together with Comic Relief, has announced £20m further funding for the Time To Change campaign against mental health stigma and discrimination, extending it until 2015. But the big question is, why is the government supporting an anti-discrimination campaign when its rhetoric in relation to welfare reform is saying something very different?

Eighty per cent of people in the Time To Change campaign’s own recent survey said they had experienced stigma and discrimination at some time; 60% say that the stigma people face is as bad as, or worse than, the symptoms, while nearly a third say that stigma has made them want to give up on life. The campaign’s view is that it has “achieved a lot in the last four years”. It says that its campaign is “based on robust evidence from other international campaigns to show what works to change public attitudes and behaviours; and it has been shown to be a cost-effective way of delivering behaviour change on a mass scale”.

There is no reason to question this. But a larger point looms. Is a public education campaign really what is needed, when the principle shapers of negative public opinion actually seem to be the government and the tabloid media?

Speaking as a long-term user of mental health services myself (who has been fortunate to escape some of the extremes of stigma and discrimination), the point that seems important to make is that it may be less a matter of educating the public, than of the government educating itself and the tabloid media. A major lead in stigmatising this group of disabled people seems to have been coming from government and its stereotyping of mental health service users in its campaigns to get people off benefits. Mental health service users are particularly targeted and recent research highlights the negative role of the media and government policy in this.

As one mental health service user, anxious to maintain her anonymity, said to me recently: Institutionalised discrimination runs through the highest levels of government and their departments. People cannot access legal aid or Citizens Advice Bureaux through cutbacks for welfare representation at tribunals. That money could fund charity/human rights lawyers to contest what’s happening to people in higher courts, or an entire advocacy service – but now, instead, it will fund this campaign.

The welfare reform programme of the coalition government has focused particularly on getting disabled people off welfare benefits, particularly the old incapacity benefit and the new employment and support allowance (ESA). In this policy, it is following the last government, which promised to get one million people off incapacity benefit. Sadly, we know that this arbitrary and unevidenced policy hits disabled people very hard. We also know that the group of disabled people it seems to hit the hardest are mental health service users – because they don’t necessarily use wheelchairs, have white sticks or clear signs of impairment. This at least sometimes means that the Benefits Agency and the Department for Work and Pensions have to acknowledge that people are not in a position to get and maintain a job in the often inflexible, discriminatory and poor-quality labour market that is out there.

This shift towards trying to force people into jobs – jobs that increasingly don’t exist and remove them from benefits – has been associated with the most harsh, cruel and inaccurate scapegoating and stigmatising of mental health service users on benefits. We know that the processes of so-called medical assessment are fiercely discriminatory. We know that many mental health service users are feeling increasingly anxious and desperate because of this, with emerging reports of suicide when people are facing the loss of benefits but no prospect of employment. Challenging mental health stigma and discrimination is one policy that needs to come from the top down, rather than the bottom up, and this is a key message for the Time To Change campaign if it is truly to punch its weight.