Can Compulsory Therapy Ever Work?

Psychiatry has often been used as a tool of state control. People who have been inconvenient or low status or cost too much to care for have been brutalised for centuries, so last weeks 'kite flying' announcement that people who are unemployed and mentally ill may be forced to attend some kind of therapy or have their benefits stopped has precedent.

Throwing an idea out without a formed policy behind it is called 'kite flying' because the people proposing it want to see how such an idea might fly. Will we rejoice that unemployed people are being further required to perform more hoop jumping or will we boggle at what a ludicrous bit of nonsense this is?

Ethically, it's a non-starter. When we begin compelling adults to have medical procedures we enter the world of ethical committees and High Courts: particularly because psychiatry has been used to abuse people compulsion in it is treated with enormous caution. This is not to say that it doesn't occur but when it's used it's almost always in a situation that is considered life threatening. People who are not sectioned but who are so depressed or anxious that they cannot work are not a threat to themselves or others.

We have evidence of what happens when we put a government agency - ATOS - between a patient and their GP. The suicide rate increases and the financial cost of appeals outweighs any savings made. The emotional cost to patients and their families is often catastrophic. There's no reason to believe this new scheme will be any different.

Therapeutically, counsellors know that a person who has been sent to therapy by a spouse, employer or parent is unlikely to do well. Therapy should never be a punishment or way of controlling someone, it has to be freely chosen. Yes, offenders are often compelled to attend therapy and what happens is that a majority learn the language of contrition rather than positively learning much about their motivations and their effect on victims.

So we know that compelled therapy is ineffective. We can also add that if this dreadful idea was ever to be implemented it would be limited to six or so sessions, which is barely enough for someone who is mildly unhappy let alone someone with a mental health diagnosis. The waiting list - already enormous for NHS and most agency therapy - would make it unmanageable and we can guess that, just as with CBT, many of the people trained for this project would not actually be therapists at all, but technicians on a budget and under pressure.

So what might the purpose of this dreadful scheme be? Would people compelled to have therapy be removed from the official numbers of the unemployed? This is what happens to people who are compelled to join other unemployment schemes so that the numbers of unemployed and particularly long term unemployed fall, on paper. If ministers wanted to help people with mental illness back to work they need to give appropriate funding to existing mental health services and reopen the services that closed because of reduced funding.

But we live in a period of time when it's not quite acceptable to throw stones at the mentally ill, yet we are encouraged to pour scorn on them if they are also unemployed. If the public mood likes the idea of punishing people who are so profoundly unwell that they have resigned themselves to living on around £100 a week then this will no doubt happen. At the very best, it will offer therapy to people who have not been able to access it. At worst it will offer dreadful non-therapy from ill-trained, ill-motivated non-therapists.

This idea slunk off in shame in 2009: there's no good reason why, 5 years later, it shouldn't slink off to die.