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The inestimable Ben Goldacre worries that doctors might be culpable in “medicalising a social problem”:
There are 2.6 million people on incapacity benefit today, after all, the largest single group of workless people, and every practical aspect of their lives, their housing, their income, their social role, is founded in an ongoing belief in themselves as incapable people, sanctioned by doctors. We haven’t really researched what the consequences of that will be.
Indeed we haven’t (and it would be tricky to get an RCT past the ethics committee). Still, we might hazard a guess that they won’t be too positive. Having a sense of oneself as autonomous and capable is a critical component of experienced well-being; the converse, enduring low self esteem and feelings of worthlessness, are well-established risk factors for mental health difficulties such as depression. Given that around 40% of people on incapacity benefit got there in the first place because of just these kinds of problems, there seems to be every possibility of vicious circles forming.
But Ben might be blaming himself, or at least his profession, a little too much here. The broader thing to notice in the debate about incapacity benefit is how the notions of “capacity” and “being in paid work” have become tacitly synonymous. Because we fail to value unpaid and voluntary activities, the only kind of contribution that the welfare system recognises as worthwhile is having a full-time job. The result is that we end up sorting people into black and white categories: those who can work (the “capable”) and those who can’t. This is deeply unhelpful, not just because of the potential impact on them as individuals but also because of the sheer waste of talent and ability.
A simple change of terminology would be a good start – just because an illness or disability limits your ability to do some kinds of work, this does not render you “incapable”. But in the longer term a smarter system, based on principles of co-production and a much more thoroughgoing concept of “value”, would surely be better for everyone concerned. nef‘s recently launched report on timebanking, a system in which people’s contribution to helping each other or an agency is valued at 1 hour = 1 credit, offers an alternative way of valuing people’s skills and knowledge. Timebanking has been particularly effective in enabling people with mental health problems to contribute to society (not least by helping in each others’ recovery) outside the sphere of the market.
Now, this is the country that brought the world the Hooters Mastercard (“It says Hooters on the card!” No kidding.) so perhaps we shouldn’t be too surprised. But who would bet against there being a similar trend in the UK?
There are several reasons we might want to worry about excessive and unsustainable borrowing, but one we should be talking about a lot more is mental health. As the new Foresight report makes clear, much of the latest research implicates debt as a major causal factor in clinical mental illness.
Today sees the launch of the government’s Foresight Project on Mental Capital and Wellbeing. nef‘s Centre for Well-being contributed two significant discussion papers to this project, which are also published today.
In Five Ways to Well-being, we reviewed the empirical evidence collected by Foresight from hundreds of research studies across the world. The outcome is a set of five different kinds of daily activity that, according to the latest and best evidence available, promote well-being and help to buffer against mental health difficulties.
With the people around you. With family, friends, colleagues and neighbours. At home, work, school or in your local community. Think of these as the cornerstones of your life and invest time in developing them. building these connections will support and enrich you every day.
Go for a walk or run. Step outside. Cycle. Play a game. Garden. Dance. Exercising makes you feel good. Most importantly, discover a phsyical activity you enjoy and one that suits your level of mobility and fitness.
Be curious. Catch sight of the beautiful. Remark on the unusual. Notice the changing seasons. Savour the moment, whether you are walking to work, eating lunch or talking to friends. Be aware of the world around you and what you are feeling. Reflecting on your experiences will help you appreciate what matters to you.
Try something new. Rediscover an old interest. Sign up for that course. Take on a different responsibility at work. Fix a bike. Learn to play an instrument or how to cook your favourite food. Set a challenge you will enjoy achieving. Learning new things will make you more confident as well as being fun.
Do something nice for a friend, or a stranger. Thanks someone. Smile. Volunteer your time. Join a community group. Look out as well as in. Seeing yourself, and your happiness, linked to the wider community can be incredibly rewarding and creates connections with the people around you.
Our second discussion paper, somewhat less glamorous but no less worthy, explored the applications of well-being research to policy. If we are to take well-being seriously as a policy goal, we need to have a robust understanding of what it is and how to go about measuring it. In the paper we describe a new, policy-relevant schematic model of well-being that we are delighted to see has found its may into the main Foresight report.