Dependency - an unhealthy state

How one kind of depression can lead to another

By February this year, there were 1.5 million people claiming Employment and Support Allowance (ESA) because they could not work due to an illness or disability. There were 96,000 Jobseeker’s Allowance (JSA) claimants, and 130,000 were on Income Support (IS). There were 10.3 million people claiming more than one benefit. 9.6 million of working age, and the rest children on Disability Living Allowance. By July, there were 7 million people claiming Universal Credit (which is gradually replacing JSA and IS) and more than a third (2.7 million) on a ‘no work requirements’ arrangement (having formerly been on ESA). Over half (51%) of households in receipt of Universal Credit included children.

The latest available data from the Department for Work and Pensions is interesting enough - well, for me at least. But these figures don’t tell the whole story. Indeed, levels of dependency are worse even than these figures suggest. As many as 9.5 million working age adults are ‘economically inactive’ - neither in work nor looking for it. Including through long-term sickness (2.8 million people) and to a lesser degree due to increasing student numbers. (Though, according to the Centre for Social Justice, a million of these are trapped on benefits but willing to work.) A million clocked-off during lockdown (700,000 declaring sickness) and haven’t clocked back in since. This is all despite job vacancies approaching 900,000, and their number being more than replaced in the workforce by first generation immigrants.

Lord Blunkett, a well regarded minister in the last Labour government, is particularly concerned about the number of young people demotivated by, and disengaging ever since, lockdown. There are, at the moment, 872,000 NEETS (young people not in education, employment or training). In 2021-22, over 60,000 16 to 24 year olds moved seamlessly from being economically inactive students to being economically inactive apparently as a consequence of illness. Blunkett is, I think, unconvinced and keen that this new government shows them some ‘tough love’:

It’s about creating a work ethic and getting up in the morning and holding a job down.

This sort of thing is good to hear, and I hope the Labour leadership have the backbone to take this approach and see it through. But it is hard to overstate what a devastating impact lockdown had on people, particularly the young. And it is the governing party that advocated the hardest for the Covid measures that have done so much damage. As Kamal Ahmed observes in The Telegraph:

Over two years the public became inured to state intervention in their lives and huge amounts of government spending to support it, money which arrived whether you were doing anything productive, or simply sitting at home. Levels of physical and mental illness leapt and many became stuck in non-working households on non-working streets, reliant on benefits to make ends meet.

And many of us remain working from home - itself an overhang from this period of passivity, self indulgence (for those who could afford to enjoy it) and inward turning. The potential social consequences, for a country already experiencing the convulsions that led to the recent riots, are bad enough. But as Alexandra Hall-Chen at the Institute of Directors puts it, this is not just a welfare problem or a challenge for a society already ill at ease with itself and recent rapid demographic changes. It’s a big economic problem for the UK too:

Without effective action to bring more people back into the workforce, sustained economic growth will be all but impossible.

And, in turn, public services will suffer too without the revenue to pay for them. But the most alarming thing is the scale and form that dependency, and this drag on our collective material wellbeing, is now taking. According to the Office for Budget Responsibility (OBR), the cost of health and disability benefits is expected to increase by a third, from £65.7 billion to £90.9 billion by 2028-29. There has been a particular rise not only in back problems (as was ever the case). But also in people claiming for mental health problems such as anxiety and depression, or because they care for children with learning disabilities and behavioural disorders such as ADHD. There has been a rise in adults with multiple long-term conditions; and 1 in 6 children and young people, says NHS England, have a ‘probable mental disorder’.

If we want to understand the numbers, it seems to me that it is the cultural underpinnings of attitudes to work, and norms about things like disability and illness - not to mention the state of the economy, childcare and the jobs market - that are critical to understanding why approaching 6 million people are on out-of-work benefits and similar numbers are claiming disability benefits. I applaud Mel Stride, former Work and Pensions Secretary, for daring to suggest that perhaps there’s something going on here. That perhaps not all of those claiming benefits in record numbers are actually as sick or disabled, or in this case as mentally unwell, as they or their parents say they are.

Could he be right, as some of us have been arguing for some considerable time, that the ‘normal anxieties of life’ are being turned into illnesses and disorders? It’s certainly got a whole lot worse since lockdown. Dr Lade Smith, president of the Royal College of Psychiatrists, was outraged by the suggestions all the same. Nevertheless, she too, I think, had a point, when she responded to Stride:

This is not simply a ‘culture’ that will go away on its own. People are not pretending to be sick – they really are sick.

I think she is wrong to imagine all of those claiming these benefits ‘really are sick’. It is highly improbable, is it not, that so many people could get so sick at the same time, with the same kinds of sicknesses? But nor are they, necessarily, making it up. I’m not sure even Stride was saying that it’s all in their heads. They are suffering from a malady of sorts - whether or not they have a medical diagnosis - and a widespread one at that. And it does indeed take a ‘cultural’ form. Not only is there a culture of vulnerability. There is also a culture of dependency.

Of course, there are plenty of people who are genuinely sick or living with conditions that mean they need support from the state. But that doesn’t explain why there are more and more of them, like never before. We are constantly being urged to seek out support and to think of ourselves as enfeebled or in need in one way or another. Is it any wonder that some are all too willing to ‘identify’ with a label that, for whatever reason, seems to fit? And instead of getting on with their life and dealing with whatever their issues are, get themselves diagnosed, signed off and turn to the state instead?

While Keir Starmer, when he was leader of the opposition, felt able to declare ‘handouts from the state do not nurture the same sense of self-reliant dignity as a fair wage’ - the fact that he felt the need to say it, and did so in the pages of the right-leaning Telegraph suggests it was a view that might not go down well elsewhere. Which is not to say a smaller benefits system that can afford to be generous to those that need the support isn’t desirable. Whether it already is or not I’ll leave to your judgement - see here for a benefit breakdown. But the benefits system does have a positive role to play in people’s lives sometimes too.

The two-child benefit cap - a cap the new government has controversially chosen to maintain - is a good example. As Ann Furedi, former chief executive of the British Pregnancy Advisory Service, argues:

Children should not be seen by the state as an expendable cost-saving. Instead, they should be cherished as an investment for the future, and in more than just a financial sense.

A concern for what state dependency does to people should be our first concern, especially now when we are seeing such high levels. That same concern should apply to those who, nevertheless, may need the support of the state - acting on our behalf as a society of individuals themselves at risk of dependency. And especially where that support is buttressing that most important institution the family. Surely, when every other lifestyle choice is celebrated regardless of its contribution to the greater good, those who commit themselves to investing in our collective future are especially deserving?

As described by Hannah Moore in The Spectator:

Marriage is the foundation of a family, a partnership formed to raise children. Getting married and having children fundamentally entails sacrificing the self for the whole.

I was unconvinced, as I explained in my last piece, with his views on housing. But I rather liked Hannah’s namesake and co-contributor Charles Moore’s (slightly tongue in cheek) take on this issue too:

Given that our indigenous population is well below replacement rate, surely the better child benefit policy would be to pay no child benefit at all until you have three children. Then you would suddenly get a massive bonus, paid out not only for the third child (and subsequent ones) but also triggering payments for the first two, until then withheld. Multiple motherhood would become a jackpot, not a burden, and the future of humanity would be secure.

And yet, he supports the (also controversial) abolition of the winter fuel payment and its replacement with a means tested benefit. I tend to agree with him. Many of those receiving the payment don’t need it. While means testing also risks less take-up just as the numbers of those living in ‘fuel poverty’ grows along with the costs to administering it, the state shouldn’t be handing out wads of up to £300 a year to people who don’t need it. I risk sounding like a technocrat when I say it, but we need a leaner, more targeted benefits system if we are to avoid promoting dependency, and ever spiralling expenditures on ever more people.

But reforming the way benefits work won’t be enough. It isn’t the system that is creating the need. It is very much the other way around. The driver of these numbers, the generator of more and more needs to be met by the state is cultural in character. It is only when we treat the sickness at the heart of a society that encourages people to clock off, and to follow a self-destructive narrative of illness, conditions and medical labels, that we can arrest the over-identification of troubled individuals with misattributed needs. We haven’t even started to do that.

I will be speaking at Neurodiversity to gender dysphoria: a problem of over-diagnosis? Part of the Ethics and Evidence strand of debates at the Battle of Ideas, in London.

Image: whoismargot