Challenging the ‘sicknote culture’ narrative
Attempting to shame people who are stigmatised serves no genuine purpose
In recent days (Spring 2024), the echoes of familiar rhetoric have resurfaced as political figures once again delve into discussions about welfare reform. The Prime Minister's recent address on the so-called 'Sicknote culture' has attempted to reignite debates surrounding welfare policies, reminiscent of language employed in the past. It's a type of language that divides, categorises, and ultimately 'others' those who access welfare state services at present, which will be in reality be all of us at some point in our lives.
Back in 2013, George Osborne popularised the phrase “strivers and skivers”, setting the stage for a decade of austerity policies. This divisive narrative conveniently fed into the fallacy of a ‘just world’, where those who struggled were somehow deserving of their circumstances. For those of us working closely with people affected by drug and alcohol use, it was a red flag. We knew then that tough times lay ahead for those in need of support.
Over the following years, mental health and substance use services bore the brunt of severe cuts, leading to overwhelmed staff, growing caseloads, and tragically whilst many people were helped drug and alcohol-related deaths increased. Years later, despite the best efforts of treatment professionals, Dame Carole Black's damning assessment in 2021 was that the drug treatment system was "not fit for purpose", a consequence of years of neglect and underfunding.
In response to the strivers/skivers rhetoric, organisations like Phoenix attempted to respond. In 2013 launched our anti-stigma campaign encouraging people to vote, enabling people affected by policy to have a say on that policy and an attempt to capture the power of storytelling to humanise people who were often reduced to mere labels. We worked with many others to create theatre, music, poetry and visual arts projects, insightful podcasts, TV documentary and inspired by Roger Ebert's quote that film is a “machine that generates empathy” (at a time when empathy seemed to be out of fashion), we launched the Recovery Street Film Festival. These projects aimed to empower individuals to share their own narratives, challenging the stereotypes perpetuated by those in positions of power.
Yet, as we mark the 10-year anniversary of the Recovery Street Film Festival in 2024, we find ourselves confronted once more with familiar language and attitudes. The resurgence of the 'Sicknote culture' narrative serves as a stark reminder of the uphill battle we continue to face in combating stigma and discrimination.
The welfare system does need reform. Through the work of the Anti-Stigma Network we know that many people face daily discrimination when accessing over-stretched state funded services. When we’re trying so hard to define substance use problems as a health, not a moral, issue the ‘Sicknote culture’ narrative only sets us back. Adding shame to discrimination serves no genuine purpose and raises the question as whether this is an attempt to weaponise stigma for political aims.
Furthermore, through the Anti-Stigma Network we’ve recently been identifying the inclusive practice of GPs to overcome the internalised shame of substance use-related stigma that causes patients to delay seeking care. Would, as the Prime Minister suggests, replacing our GPs with an "objective assessment" by unspecified "specialist work and health professionals" reduce barriers to care? or will it just create more barriers to welfare?
We need a fundamental shift in approach to accessing welfare services. Instead of gatekeeping access to services and rationing care, we need to make it easier for people to live healthily. Services should be designed with the input of those directly affected, grounded in empathy and respect rather than judgement and labels.
