It’s been a bad few of months for me as disabled benefit scrounger (I guess I still qualify since I am unemployed and don’t have any regular income source other than DLA). First of all there was George Osborn’s October speech in which he asked where “the fairness” was “for the shift worker, leaving home in the dark hours of the early morning, who looks up at the closed blinds of their next-door neighbor sleeping off a life on benefits?”
Well, since you ask, George, yes I am sleeping my life away, jobless. Not because I don’t see why I should bother getting up, but because my current dose of antipsychotic is such that I sleep up to 12 hours a day. That’s just what it takes to get my moods near enough stable, so that I am less of a drain on primary care and my mental health team. I understand that from the outside, it may look like I’m lazy, answering the door to the postman in my dressing gown at 11am, but often that is the earliest I can drag myself back to consciousness. It’s not like I go to bed late; I hardly ever experience that simple pleasure of pillow talk, because I’m usually fast asleep by the time my partner’s ready for bed. Because you see, that’s the problem with jumping to conclusions. A closed blind is simply a closed blind; the “striver” leaving for work has no means of guessing at his neighbour’s true circumstances behind that blind.
This week, it was the turn of obese benefit claimants to be singled out. A local authority and a conservative think tank have built on suggestions that benefits could be dispensed via “smart cards”, floating the idea that benefits claimants’ use of leisure facilities to improve their health could be monitored via the cards. Obese or otherwise unhealthy claimants who fail to carry out exercise programmes prescribed by their GP could, the report suggests, have housing or council tax benefits reduced for non-compliance.
What do you know, according to my BMI calculator, I am obese as well as lazy. I’ve gone beyond the “overweight” band and have become what NHS Choices describes as “somebody who is very overweight with a high degree of body fat.” I’m clearly not alone; at a 16, I am now the size of the average British woman. NHS Choices goes on to tell me that my obesity places me at risk of a number of serious health conditions – Type 2 diabetes, diseases of the cardiovascular system such as heart disease and stroke, and even certain cancers (in particular breast and colon cancer).
So who in their right mind would let themselves become and remain obese, with all the attendant risks? My problem, of course, is that I am often not in my right mind, and the treatments for bipolar increase the risk of obesity. Sleeping 11-12 hours a day (with my blinds drawn) automatically makes my lifestyle more sedentary than most people’s. Then there’s the fact that both quetiapine and lithium have a reputation for stimulating appetite causing weight gain in users.
But there are plenty of people without mental health difficulties who find it impossible to keep to a “healthy” weight for various reasons. There are vast numbers taking other sedative medications for chronic pain or life-threatening diseases. Physically illness or disability may also reduce a person’s ability to participate in mainstream exercise. Despite the prominence of the 2012 Paralympics, many gyms and swimming pools still lack the resources to allow people with mobility problems to use their facilities, and staff have insufficient knowledge about how to help disabled people use equipment. Even people who are entirely well and able-bodied clearly find it difficult to incorporate exercise into their working lives or parenting/caring responsibilities. Our environment has been described as “obesogenic” – never have so many calories been available to us so easily, and never have we used our bodies less.
I should, of course, do something about it. Would it help if my GP prescribed attendance at a fitness activity, such as a walking club, gym or swimming pool? Not really. Because if I am feeling well and stable, I am able to motivate myself to exercise anyway. But if I am feeling depressed or anxious, it will be difficult enough for me to manage to leave the house, and I will experience social anxiety that makes it very hard to attend unfamiliar groups and locations. I worry about my body size and shape anyway; if I am feeling low, my self-disgust reaches epic proportions, making it highly unlikely I will want to exercise publically. If I am manic, I will forget all about what I am supposed to do and ditch my gym sessions for socializing or writing; if I do remember I need to go, I won’t see the point because I will believe that I am already 100% gorgeous. I already experience all these emotional difficulties attached to exercising in a park or leisure centre. Now imagine that in addition to the distress caused by my bipolar, and all the anxieties about what my obesity may be doing to me, I have to worry that I will face economic sanctions if I don’t make it the gym.
What I find most offensive about this suggestion is that it treats a prescription as if it is a sentence. All of us are free to obtain medical opinion, but we are also free not to take up the suggested treatment. So long as we possess the capacity to make decisions about our health, we are entirely within our rights to say to a medical practitioner, “Thanks for your advice, but I have thought it over, and decided not to take up treatment” – even if it is likely that our lives with be shortened by that decision. A person with cancer, for example, is at perfect liberty not to accept surgery or chemotherapy, even if this means there is a greater chance that they will not survive. As long as they are capable of understanding the risks and the benefits of the proposed treatment plan, as an autonomous adult they can refuse something which most would see as clearly good for them.
For several years I worked in a multiagency serious substance misuse team, where practitioners from the police and probation services, drug treatment agencies and housing and employment services came together to support people with entrenched opiate and or stimulant use. Our aim was to help them in getting clean and avoiding further criminal activity. Often our clients were presented with a stark choice by Magistrates, weary of seeing them in their local Court over and over again: engage in a community Drug Rehabilitation Requirement, or go to custody. It may not have been much of a choice, but it was, nonetheless, a choice. Magistrates and Judges cannot sentence someone to community drug treatment unless a) the drug treatment provider agrees that the offender requires treatment, b) and the offender signs an agreement indicating their willingness to participate. Once they’ve said yes, however, they are committed to that option; if they persistently fail to attend for drug testing, key work sessions or the groupwork programme, they will be deemed to be in breach of their Community Order and will be brought back before the Court, where they may be resentenced to a stiffer punishment.
The reason that clients were required to give their permission is simple: people cannot be forced to undergo medical treatment unless they come under the remit of the Mental Health Act or the Mental Capacity Act. However, once under sentence, they faced serious consequences for failure to engage. Once sanctions become attached to non-attendance, people are no longer freely choosing continue with the treatment. If people with weight problems get the sense that they are being “sentenced” to exercise, rather than it being offered via prescription, they are likely to begin viewing GPs with some of the mistrust and hostility with which defendants view sentencers – and this would be absolutely disastrous for people with those very health conditions we know are linked to obesity. And if GPs begin to feel that the treatment they are offering is coercive, rather than supportive, serious questions about the ethics of that may lead them to cease prescribing exercise for the people who need it most.
Who, exactly, will that benefit?