It’s actually quite incredible to see positive, rights-focused mental health proposals be the first policy announcement of the Conservative Party at a general election. It shows just how far our culture has changed with respect to mental health, and it’s testimony to campaigns such as Time to Change and the work of people like Paul Farmer that political parties feel both motivated and permitted to advocate such change. It’s not so long ago that mental health policy was primarily about public safety and driven by fear.
Two lessons emerge out of this for me. The first is that some aspects of disability rights chime strongly with a Conservative worldview and are deemed to offer electoral advantage. Here they are proposing to reduce detention, non-consensual treatment and to strengthen protection from discrimination by amending the definition of disability in the Equality Act. All of these issues were raised in the UNCRPD Committee’s list of issues for the UK. If carried though and carried through well they will mark a step forward for disabled peoples human rights. The Party also announced a further 10000 specialist mental health nurses by 2020. While the latter involves a commitment of public money (albeit not necessarily ‘new’ money), the overall thrust of the policies is strongly in line with Conservative values of individual liberty and opportunity – of keeping an overreaching State in check and focusing resources on supporting individual agency and enterprise. A look back to the last time the Conservatives held a majority in Parliament reveals progressive disability policies also rooted in these values: the Direct Payments Act, the Disability Discrimination Act and the introduction of Disability Living Allowance. It interests me today that, while the cut to the Employment and Support Allowance Work Related Activity Premium passed largely unopposed by Tories in Parliament, many expressed deep opposition to further cuts to the Personal Independence Payment. Of course, PIP was and is designed to constrain spending on disability benefits, but it seems that Tories intuit it in a different way to out of work benefits and those intuitions can be harnessed to positive effect (while perhaps having to accept that there will be little if any out of work disability benefits by the mid 2020s). If we are to achieve further progress, understanding these intuitions and finding ways to appeal to them through strategic prioritization and framing will be key. Policy asks focused on and framed as extending freedom, nurturing agency and supporting people to get on in life are much more likely to find currency than those framed simply as being about the amount of social security money in people’s pockets. While opportunities to secure higher spending may be few and far between, opportunities to secure smarter spending, in line with these values could help for example in resisting the forces of re-institutionalisation at play among local councils and CCGs.
There are also significant signs that May is shifting her party away from the economic liberalism that has dominated politics for the past 30 years – and indeed one can regard the EU referendum vote and support for Brexit as endorsing such a shift. The policy announcement on capping energy prices is a concrete sign of intent. Will this see the deregulatory zeal of those on the right of her party kept at bay? Does this create a space for a renewed discussion about tackling disability discrimination in the labour market, led perhaps by the scrapping of employment tribunal fees? Will May’s government be prepared to wield both carrot and stick when it comes to employers? How about service providers? Might we anticipate stronger action on accessible goods, facilities and services? What about the proposals of Scope’s Extra Costs Commission that focus on market regulation to reduce the disability related costs of living?
Of course the Tories’ agenda on disability will be seriously wanting in many respects, particularly where it comes to spending on financial and practical support. This has and continues to be the historic fault-line when it comes to securing progress on disability rights. Labour may be the party of the NHS and more generous State support for poor people, but it is also the party of community treatment orders, of putting public sector workers above those relying on services and of often being deeply suspicious of measures to accord people more control over services and support, such as via personal health budgets, all of which undermine disabled people’s right to autonomy.
All human rights are ‘interdependent and interrelated’ in theory, but in practice different political systems and parties always tend to emphasise one class of rights above another: civil and political rights or economic and social rights. As I have said before, this creates a ‘Hobson’s choice’ for disability rights which makes little sense unless one abandons these distinctions altogether. The right to independent living for example relies on meaningful freedom to make choices about where and with whom to live on an equal basis with others. Legal safeguards and administrative mechanisms such as direct payments may accord a degree of control, but if a person has insufficient resources or options from which to choose the right is rendered fairly meaningless. The same point has been made about the Conservative proposals on mental health – how can we expect to reduce detention when support to live in the community has been so eviscerated?
Clearly disability rights campaigners have to continue to defend and pursue more generous and more effective investment of public resources and to expose the impact of disinvestment in disabled people’s opportunities and wellbeing. But they also need to get much smarter about the way they do so. The lesson of the announcement on mental health policy is to avoid the trap of wholesale political opposition, as has so often been the case among some of the noisier members of the new school of disability activism since 2010 (see DPAC’s current election campaign against ‘Tory vermin’ for example). There will always be a role for protesting outside the tent. But there is an equally valid and important role for the ‘negotiators’ who find opportunities to work respectfully with government and political parties of all sides to secure progress, while also being clear about red lines.
With the likelihood of at least a decade of Conservative government in front of us, the negotiators are needed more than ever before.