Rishi Sunak punishes the sick to cover up his own failures | Letters

As a retired GP who spent 35 years in primary care caring for people with anxiety and depression, I find Rishi Sunak’s recent comments about GPs ‘over-medicalising’ life’s daily challenges and concerns insulting (Sunak quotes the UK’s ‘sicknote- culture’ in bid to overhaul the fit note system, April 19). These disabling problems account for approximately 40% of all primary care practices.

He clearly has no idea what is going on in his country. People are suffering from multiple stresses, including enormous financial pressure, largely caused by the total incompetence of his own party over the past fourteen years. People are quite resilient when they face stressful setbacks in their lives, such as bereavement, job loss or debt, but if they encounter something bad again, they ‘hit a wall’ and can’t move on. It seems to be a fixed mechanism that ensures that they cannot continue any further.

Often all they need is to step back from the edge and take a short break, with the GP’s role central as provider of the ‘fit tone’ and some compassionate emotional support. The GP assesses the degree of need and can possibly provide signposts to debt advice or mental health care, which have of course been cut to the bone. Often people wait many weeks or months before admitting that they are too sick to work, and they continue to try relentlessly and only get worse.

The suggestion that some “specialist work and health professionals” are perfectly capable of keeping them slogging away at work anyway is ridiculous. Even more unlikely is the suggestion that “tailored support” would be provided.

I find insulting the suggestion that GPs cannot be ‘objective’ in assessing their patients and that some minimally competent ‘other’ following an algorithm will magically bring them to recovery. It is laughable, ill-informed and can tragically drive some people to suicide. If I were extremely cynical, I would of course recognize that dead people are not entitled to sick pay.
Dr. Maureen Tilford
London

I would like to tell Rishi Sunak about the application my mentally ill sister made for Personal Independence Allowance (Pip) in 2017, whilst living in her own home on anti-psychotic medication and under a mental health care order (Sunak accused of making mental health problems). disease ‘another front in the culture wars’, April 19).

Nevertheless, the application was rejected due to a lack of sufficient evidence. The evaluators had goals to reject claimants, so they had to reject some of their cases regardless of their merits, and this was clearly a case of necessity. But there were no targets for rejecting appeals. My sister’s case was accepted on appeal, based on much the same evidence. The process lasted eight months from the initial claim and was completely retroactive.

But I had to call the Department for Work and Pensions to tell them that the letter informing my desperate and financially destitute sister that she had been entitled to Pip all along had arrived three weeks after she committed suicide. I could hear the horror in the DWP worker’s voice when I told her, because she was the one who had both rejected the original claim and accepted the appeal.

I believed then, as now, that if the state had actually cared about those in need instead of looking for ways to undermine claims by hook or by crook, it could have given my sister the will to carry on . My sister was one of many. Sunak wants to increase this practice. It can only lead to more suffering and more deaths.
Mark Lewinski-Grende
Swaffham Prior, Cambridgeshire

Rishi Sunak’s entry into the Tory war on people on disability benefits is the latest in a long line of attacks that routinely undermine many people with long-term conditions whose health and abilities will never improve. My wife suffered traumatic brain and other physical injuries in a road accident in 1982. Under a Tory government in the 1990s, the then Department of Social Security confirmed her benefits under a lifetime ruling.

They were regularly reviewed under the post-2010 Tory government. In 2018, she lost Pip’s increased rate because it was assumed that she could plan and undertake a trip. I love her very much, but she can’t plan her way out of a paper bag.
Name and address provided

If Rishi Sunak wants to tackle ‘sick note culture’ and reduce the number of people queuing for mental health care, he has a simple remedy at his disposal. All he needs to do is resign, call a general election and make way for a more competent and caring administration. The national mood would rise by leaps and bounds, and millions of people would immediately feel better at the prospect of light, however faint, at the end of our current endlessly dark tunnel.
Maggie Black
Oxford

Rishi Sunak’s speech last week claimed we are over-medicalising the ordinary ups and downs of life, with people using psychiatric labels and sick notes to avoid having to work. His solution for both people and services is to work harder, raising the bar for receiving sick leave and healthcare support. The explicit aim is to reduce disability bills, NHS waiting lists and costly absenteeism. The secret aim is to deny that there are high levels of debilitating mental distress in Britain, and that this distress is rooted in social causes that need to be addressed.

The research into the social determinants of poor mental health is comprehensive and shows that increasing mental health problems are inextricably linked to the context in which people live and work. As recent World Health Organization Report shows that deteriorating mental health in the workplace is caused by social factors such as wage inequality, excessive workload, low control and job insecurity, demoralization and dissatisfaction in the workplace.

So yes, increasing need may not be a medical problem, as Sunak claims, but it is certainly a social problem, as Sunak ignores.

We need to stop overmedicalizing mental health problems. As a psychological therapist, I know firsthand that most people who seek help are not suffering from “mental illness” in the biologically verifiable sense, but from understandable reactions to living and working conditions that harm and hold them back; conditions for which medicine was never intended. By misrepresenting socially induced suffering as a medical problem, we risk wrongly individualizing, pathologizing, and ultimately depoliticizing that suffering, thereby absolving social conditions of responsibility.

Over-medicalisation is indeed a problem, but not for the reasons Sunak thinks.
Dr. James Davies
Associate Professor of Psychology and Medical Anthropology, University of Roehampton; author of Sedated: How Modern Capitalism Has Created Our Mental Health Crisis