The most undeserving poor?

The Secretary of State for Work and Pensions, James Purnell, proposes removing payment of benefits from unemployed persons with addiction to crack cocaine and heroin. ^1,2 The proposed Green Paper ³ sets a remarkable precedent in terms of official, inter-agency response to that common mental disorder described as ‘drug addiction’. It focuses on benefits (to an estimated 267 000 individuals in England alone) for those ‘dependent on drugs’ or ‘problematic drug users’. ⁴ Little attempt is made to distinguish between degrees of dependence or recreational use. The Green Paper claims that ‘this is around three-quarters’ of all the people who are ‘dependent on these drugs’. ³

It states ‘we believe that drug misuse is a serious cause of worklessness and that individuals have a responsibility to declare it and take steps to overcome it’ (section 2.40). At present only 0.05% of people on jobseekers allowance declare an addiction. ³

All applicants will be required ‘to declare whether they are addicted to heroin or crack cocaine’ (section 2.39) with investigations for fraud against those who ‘mislead’ and they will ‘be required to enter treatment’ (section 2.41–2.43). Proposals include new powers to force agencies such as ‘drug workers’ (section 2.38) to disclose clinical information. It seems inevitable that at least forensic and prison doctors will have to ‘share information’, and National Health Service psychiatrists will become complicit in informing job centres as part of multi-disciplinary teams.

Given the known morbidity of addiction, ⁵ we know of no other psychiatric disorder that excludes citizens from access to statutory services!

For practising clinicians, the proposed legislation strikes at the core of the doctor–patient relationship, destroying medical confidentiality and grossly interfering in treatment. Therapy is often episodic and incremental but in future doctors will hesitate to end an episode of failing treatment for fear of depriving their patients of food and sustenance. How will clinicians establish working relationships with their patients while simultaneously policing the state benefit system? Politicians, high on prejudice, are driving a coach and horses through the subtle art of treatment. Where is the dissenting outcry from the profession and the Royal College of Psychiatrists? If doctors do not speak up for their most vulnerable patients, who will?