Wessely & Smith (2015): "Linking benefits to treatment is unethical and probably illegal"

I just came across this, from 2015:
https://www.theguardian.com/comment...-people-mental-health-problems-work-treatment

Which I completely agree with, but was surprised to see Wessely saying it. Isn't it his sort of work that gets used to refuse benefits to ME/CFS sufferers or even to coerce them into particular treatments under threat of losing benefits or insurance?

 

I saw this piece as good positioning from him. He knew that the benefit reforms that were ideologically tied to his work had become a PR disaster, and that the talk of forced treatment for claimants was never going to fly with the medical profession, so here was a good way for him to get out in front of things and present himself as standing up for the rights of benefit claimants.

 

Wessely has a habit of saying things he doesn't believe because it makes him look good. Then saying the opposite if it also makes him look good. Definitely a PR move here.

By all accounts the system he has promoted for ME/MUS is so much worse than this. Tying a treatment to benefits is bad enough, he tied all support systems, including familial, to a worthless, even harmful, treatment and recommends a refusal of medical care following deterioration by merely arguing, against all evidence, that it cannot possibly do harm.

It's certainly correct that it is unethical and probably illegal, and yet he supports it in some areas. What a weird, discombobulated moral system this guy has. As moral compasses go, his is basically a wet noodle caught in a whirlpool.

 

@Esther12

Don't know what I missed, but I thought most or many doctors were/are going along with the forced treatment as a condition of ME patients being approved for their disability claims. I thought that was a common circumstance. Maybe I've misunderstood your post?

 

I doubt that doctors have 'gone along with forced treatment'. Doctors will have recommended the treatment only if they think it would be helpful (which many will have). They would not be involved in any decision about whether or not benefits were dependent on that I think. So I don't think there would be any suggestion of going along with forced treatment. They might be aware of a requirement but that need not affect their decision.

I think that the medical profession would have been totally against any suggestion that they had to prescribe treatment so that people could get benefits, rather than because they thought it was good for them, which I think is what E12 is implying. This would be an infringement of the heavily protected concept of 'clinical judgment' which ensures that a doctor can always decide what they personally think is best for the patient (as long as someone else is paying).

 

There are also things like this from Wessely: https://www.s4me.info/threads/simon-wessely-research-related-quotes.1304/#post-22188

eg:

In practical terms, this can lead to patients feeling forced to do CBT/GET, and some insurance companies have been explicit that patients are required to engage in treatments the patient believes will not be useful in order to be eligible for disability payments, but that's not seen as going as far as the state forcing treatments on patients. Particularly in the context of the bad publicity recent disability reforms have already had, there was no way the UK medical authorities were going to go along with that.

 

So that is pretty much half way in between I guess.

I did not get involved in medical retirement or permanent disability sign offs much but I suspect that psychiatrists do more. I had plenty of people with RA in the early days who had to take medical retirement but I suspect it was so obvious to all concerned that I was never required to give approval.

Sign offs for medical retirement are also often done by specialists who are not routinely involved in that persons care so not necessarily their medical attendant.

 

So it seems to be a hybrid. One's doctor might object to the CBT/GET, but a private disability insurer might insist, which is outside the physician's control.

Although as per @Esther12's post and link above, "all reasonable efforts at rehab", would very likely include CBT/GET when being assessed by the BPS individuals.



Thank you for both you comments, and explanations, @Esther12 and @Jonathan Edwards.

I hope an increasing number of medical professionals are learning CBT and GET for ME is at best not effective, and at worst could cause harm.

 

In practical terms, in Australia, the government has decided which theory to support. They’ve chosen their “medical expert” who believes firmly in CBT/GET and doctors who do not agree have their clinical recommendations for their patients ignored. So the situation is that patients are denied benefits if they do not undergo CBT/GET even if their doctor recommends against it. Patients are expected to find someone who will treat them with CBT/GET. So while not technically a forced treatment, you cannot refuse that treatment and receive benefits without a great deal of unnecessary holdups and several levels of appeals and tribunal.

 

Thank you @sea for your comments. So the authorities avoid the outright ban of benefits for pwME who have not tried CBT/GET - so they look more humanistic, avoid law suits, or whatever the case is for them, but pwME still go through a terrible time, and the potential for harm.

In Canada, Health Canada "supported" the Cochrane review on GET and CBT for ME - I don't know if this was turned into policy - I don't think so. Perhaps private insurers took it up. I don't know.

Government and private insurers here have certainly made it difficult for many if not most with ME.

Personally, I saw a health professional, (not a doctor) who repeatedly insisted that having a rigorous fitness program would cure me, however, he couldn't enforce this.

 

@DokaGirl yes there is no outright ban, it comes down to how the legislation is interpreted. So to be eligible for benefits one of the conditions is that you must be fully treated. What that means in this context is that you must have tried every treatment that is “reasonable” with regard to cost, availability, risk and likelihood of being effective. Reasonable is up for interpretation. There is a huge gap in our system for supporting those who are obviously not well enough to work yet don’t meet the criteria for being fully diagnosed and fully treated.

 

One of our members has said that she was forced to let her child undergo CBT and GET because if she refused her child would be taken into care. And then there is being sectioned if we do not take the treatment voluntarily. We know these things happen so we are all vulnerable to it.

Don't see SW doing anything about that.