Marxism and mental health (audio)

Mental HealthFightback’s Polly Peek recently spoke on the topic of Marxism and mental health in Christchurch.

Capitalism functions in such a way that people impacted by mental illness are often lacking the health services needed, and face discrimination in employment and stigmatisation in wider society.

Downloadable MP3 available here

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Putting the care into aged care

Upper Hutt aged care picket2 1.3.12

Grant Brookes, Health First candidate for Capital & Coast District Health Board

Aged care is in crisis. It’s headline news. In August, pay cuts of up to $100 a week for staff at Ranfurly Rest Home and Hospital in Auckland were the lead story on Campbell Live (When your employer proposes a pay cut). In early September, an inquiry into shocking neglect of elderly residents at Wellington’s Malvina Major Home was front page news in the Dominion Post (Rest Home failed all its residents, Ministry says)

Although the mainstream media reported these as isolated issues, in reality they are the tip of an iceberg.

The systemic crisis has been clear for at least the last three years. In 2010, opposition MPs Sue Kedgley and Winnie Laban led an alternative inquiry into aged care, after National Party members of the health select committee blocked a formal parliamentary inquiry. (October 2010 Aged Care Report)

And it was confirmed last December by the Caring Counts report, published by the Human Rights Commission. This found that the predominantly female workforce in aged care – many of whom are new migrants – and the elderly people they look after are undervalued and discriminated against. (Report of the Inquiry into the Aged Care Workforce)

The situation for support workers, often working alone to help elderly people in their homes, is largely invisible. But it’s probably even worse.

Aged care in New Zealand is suffering the ravages of neoliberal capitalism. Today’s crisis flows from the privatisation and deregulation of the sector over the last 25 years.

Up until the 1980s, rest homes were mainly run by charities. But by 2010, over two thirds of residential facilities were privately owned and run for profit.

The industry is dominated by multinational corporations, banks and private equity firms. A third of the beds nationwide are provided by six large chains.

One of them is Ryman Healthcare. Ryman owns the Malvina Major Home, of Dominion Post fame, where a confused elderly woman was repeatedly left lying in her own faeces.

In the 1980s and 1990s, there were legal minimum staffing levels for homes like this. But in 2002, deregulation removed minimum staffing requirements.

Ryman Healthcare receives $800 million a year from the taxpayer. How much of this goes straight into the pockets of investors is unknown, as the company is not obliged to account for this public money.

It is known, however, that on night shifts they employ just one or two nurses to look after the 200 residents at Malvina Major. Is it any wonder that residents are sometimes neglected?

The aged care crisis has been the focus of a decade of campaigning by the three unions representing in the sector – the Nurses Organisation, the Service & Food Workers Union Nga Ringa Tota and the PSA.

But the proportion of workers who belong to a union, while higher than the private sector average, is much lower than in the public health system.

In 2006, union density across aged care averaged 20 percent. This has weakened the ability of workers use industrial action to press for change.

Despite this, aged care has featured prominently in strike statistics in recent years, winning modest improvements (or limiting the deterioration) for workers and residents in some places.

But given the relative industrial weakness, the unions have also turned to political campaigning. Because District Health Boards administer the funding contracts with aged care providers, elected members of the DHBs do have some influence.

The PSA is lobbying DHB candidates to commit to pay justice for contracted out home support workers, including equal pay with those directly employed by the DHBs (Time to Care).

The SFWU is calling on DHB candidates to support its Living Wage campaign (www.livingwage.org.nz), and its minimum hourly rate of $18.40.

And the Nurses Organisation is asking candidates to sign a pledge, including commitments to the Living Wage and equal pay for nurses and caregivers in aged care compared with their DHB counterparts (DHB Elections 2013, NZNO).

Standing as a candidate for Capital & Coast District Health Board, I am proud to continue my years of involvement in the battle for aged care by supporting these union campaigns.

Politics and the mental health consumer movement

changing minds

Polly Peek

As a socialist and mental health consumer, I was recently excited to discover ‘The C Word,’ a blog on the Changing Minds website.

Changing Minds is a consumer organisation based in Auckland. Engaging in systemic advocacy and activism, the group acts as a network of mutual support for people who have used mental health services and want to be involved in improving the health system.

What’s exciting about this organisation and the information they’re providing for mental health consumers, is that they seem to be taking an openly political approach to their work, recognising the impact our material conditions have on all other aspects of our lives – including health and wellbeing.

The first C word examined in the changing minds blog is Capitalism.

“Capitalism” the author states, “is bad for my health. And in my opinion, it’s bad for everyone’s health”. Issues related to low wages and systemic unemployment are raised, and the inability to maintain a work-life balance within the present economic system is related to the people’s needs for rest, particularly where someone is managing mental distress.

The article goes on to discuss how the polarities of full-time or over-employment and unemployment are legitimised through an ideological equation of full-time work with full citizenship – a status unattainable to many mental health consumers due to the demanding nature of work under capitalism.

It is interesting to consider this blog post in relation to the politics of the wider mental health consumer movement. [Read more…]

A radical mental health consumer’s thoughts on the welfare reforms

Welfare reform will have a negative effect on those experiencing mental illness or distress

Welfare reform will have a negative effect on those experiencing mental illness or distress

Polly Peek

This month, the Mental Health Foundation is organising activities and events for Mental Health Awareness Week. For the last few years, the theme of awareness week has been based on the ‘Five Winning Ways to Wellbeing’, the essence of a number of studies into what makes people (whether labelled with a mental illness or not) well and happy. From the research, five key aspects of wellness have been identified, namely, connecting with others – family or friends, being active, keeping learning, taking notice of the small things around us, and giving to others.

For people living with the assistance of welfare benefits, ‘giving’, this important aspect of wellness is considerably restricted. Not only do most people living on state assistance receive less than is adequate to look after themselves, let alone have surplus to give to charity or lend to friends in need, but they are also excluded from offering their time voluntarily to charitable organisations or community groups as Work and Income policy sees this as potentially interfering with their ability to find work, or, if they are receiving a Sickness or Invalids benefit, proof of their ability to be in paid employment. I spoke with one such person a few days ago who has received support for a long period of time due to disability and she expressed sadness and frustration that a person she knows in a similar situation is having to hide the fact that they are helping out with a local charity from WINZ.

Recently, the government has revealed welfare reforms which will have a further dire impact on people’s mental health and that of mental health consumers in particular. These follow an initial wave of welfare reforms which have made changes to assistance available to youth in particular. Announced changes to welfare policy include completely cancelling assistance for three months for people who are considered to have turned down a suitable job, halving assistance for people whose children are not enrolled with a GP or early childcare centre, and cutting assistance for people who fail or refuse a drug test at a new job, or have outstanding arrest warrants. [Read more…]

The dialectical relationship between work and mental health – Part 4

This is the final instalment of a four-part series by Polly Peek

From a Marxist perspective, the low pay rates of jobs with low psycho-social quality is related to the concept of exploitation – the necessity for wages to be worth less than the value created by the worker’s labour, in order to continue to make a profit. A further component of employment’s potential detriment to mental health, well-being and recovery which is not covered in the research carried out by Butterworth and other (see part 3), is workers’ experiences of alienation. In his book which looks at work and sickness, Paul Bellaby discusses the way in which jobs can accentuate certain qualities of the body and mind, but can also depreciate others. A participant from one of the qualitative interviews quoted in this book talks about alienation with great clarity, as well as its impact on well-being as a worker undertaking solitary tasks.

You hardly talk to anyone. You have no idea what is happening around you – and you lose touch with what is happening in the world. After a while it gets so that you have no conversation, and when you go out socially you do not know what to say – eventually you lose all your self-confidence. (Bellaby) [Read more…]

The dialectical relationship between work and mental health: part 3

This article is part three in a series of articles by Polly Peek. The first two parts can be read in the January and February issues of The Spark or online here (part 1) and here (part 2)

The low employment rates for people experiencing mental ill health can be attributed to a combination of individual discrimination and, more predominantly, systemic barriers. Research into occupational perspectives on recovery by Mary Kelly, Scott Lamont and Scott Brunero, highlighted the experiences of a mental health consumer who was forced to take early retirement by his employers upon disclosure that he was seeing a psychiatrist. This kind of anecdotal evidence may give perspective to the question of whether mental ill health leads to unemployment, or loss of employment erodes resiliency with the suggestion that where illness leads to unemployment, it may, in many cases not result exclusively from symptom recovery but external issues such as inter-personal discrimination.

I would argue that in these situations individual discrimination is a result of a wider systemic issue that is the bottom-line focus of businesses. This priority is evident in research such as that produced by London School of Economics and Political Science researchers which outlines the 10 billion pound annual loss to businesses as a result of “failure of employees to fulfil their contractual hours” while absent from work sick. Extending on this, the authors cite the increasing presence of mental illness in the global burden of disease as a reason for some people being absent from work up to three times as often as their colleagues. While similar finding have featured in New Zealand research such as that undertaken by Southern Cross, and cited in the NZ Herald in 2009, more attention to the abilities of employers to reduce the impact of mental illness on workplace performance could improve employment opportunities for people with mental illness in the absence of a larger societal change away from prioritising profit. [Read more…]

The Dialectical Relationship between Work and Mental Health: part 2

This article is the second of a four-part series by Polly Peek. The first part can be read online here or in the December-January issue of The Spark. ‘Consumer’ in this article refers to a person who currently or has previously used psychiatric services. ‘Bourdieuian’ refers to the theories developed by French Sociologist Piere Bourdieu and  ‘taangatawhaiora’ is a Te Reo term that translates to ‘person seeking well-being’.

The instrumental value of employment is that it creates opportunities for mental health consumers to access additional resources to improve their health and wellbeing such as financial resources and supportive social networks. From a Bourdieuian perspective, therefore, employment allows people with experience of mental illness to beneficially increase their social and economic capital. The benefit of these resources has been expanded on in research exploring resilience factors for mental health. One example of this is a 2002 Ministry of Health publication which cites economic security as being crucial for well-being as well as the availability of opportunities. Because of the lower-than-minimum-wage rate of benefits in New Zealand society and difficulties attaining work without experience, the mental health benefits that come from economic security and accessibility of opportunities is likely to disproportionately benefit those in paid work in comparison to the unemployed.

[Read more…]

The Dialectical Relationship between Work and Mental Health (Part 1)

is work good for mental health? This article is the first in series by Polly Peek addressing the issues of work and mental health from Marxist perspective. For more information on the concept of dialectics see http://www.marxists.org/glossary/terms/d/i.htmIn this article the term ‘mental health community’ refers to those people experiencing mental illness or distress, and ‘consumer’ refers to those using or having previously used psychiatric services.. The role work plays in the mental health of people experiencing mental illness is complex, with research on the topic appearing somewhat contradictory on the surface, the most prominent contradiction being whether work is overall beneficial or detrimental to well-being and recovery. Research suggests that employment, or engagement in meaningful contribution is a “critical component of the pathway to recovery” (Mental Health Commission, 2001, cited in Duncan and Peterson, 2007) and that the most significant employment challenge for people experiencing mental illness is overcoming structural barriers to attaining work. At the same time, other studies indicate that the correlation between work and wellness is not so clear-cut, and that the kinds of jobs most accessible to the mental health community are also those with the highest likelihood of decreasingwell-being and obstructing recovery. In approaching this conflict through a dialectical analysis, the question of interplay between work and mental health moves from one of ‘is work more beneficial or detrimental to recovery and wellbeing’ to one of ‘how can the contradictions of employment’s simultaneous facilitation and eroding of wellness be resolved’. [Read more…]