Medicandus

Medicandus

‘Bad backs, a bit of depression and so on’ - a throwaway line for some, a life sentence for others

Former prime minister Tony Abbott was widely reported in the media for remarks he made about the Disability Support Pension (DSP) while being interviewed on radio. This was a few days ago now, and no doubt Mr Abbott has gone on with his backbench duties and is perhaps getting ready for Christmas with his family. It’s old news now in media terms but the damage it has caused will go on for the people most affected by his talking point.

While I acknowledge you can’t be right all the time, and Mr Abbott may not necessarily have the chance to prepare for public statements when put on the spot, some of the comments he made regarding DSP eligibility were frankly misconceived.

Following the last article I wrote in this column about DSP eligibility, I was contacted by a former Commonwealth-employed doctor. He wholeheartedly agreed with my view that independent medical examinations for DSP recipients were a waste of time and money.

He further wanted me to know that in his experience of conducting perhaps 10,000 examinations over the course of more than a decade, the number of malingerers he identified was in single figures. The experience of doctors like him was one of the main reasons why the system was changed to make the treating doctors the gatekeepers for medical assessment. All the evidence was they were doing a very good job at keeping out people who were ineligible.

It would appear to be a hallmark of Mr Abbott’s political career to ignore evidence when an ideological point can be made. It was his government’s direction to the NHMRC to waste time and money examining unscientific beliefs regarding “Wind Turbine Syndrome”, water fluoridation and homoeopathy. Money was no object when it came to stopping the boats, and apparently the same goes for cracking down on virtually non-existent DSP frauds.

For the former PM to say publicly that under his government, too many people were put onto the DSP is misguided for number of reasons. Firstly, and most obviously, he implies he has some predetermined knowledge of exactly what the correct number of DSP recipients in Australia is supposed to be.

Secondly, it implies ineligible individuals are being inappropriately placed onto DSP. Finally, he seems oddly ill-advised about major public health issues like depression and chronic pain, and the role they have in creating disability.

I have heard from many on the right of politics there are two problems with DSP recipients from a policy and economic point of view. Firstly, too many people are being given it, and secondly too few people are coming off it.

The second objection is the easier to deal with. The point of the DSP is it provides income support for individuals who are permanently unfit to work. I would have thought if the system was perfect nobody would ever come off. It should be difficult to gain access to for malingerers or those who are expected to recover and return to the workforce. A DSP which is fit for purpose should provide lifelong support for those with permanent problems. It is therefore fatuous to object that people are staying on for too long.

The first of the above objections is the bone of contention. I argue from both my own experiences and those of numerous of my patients the eligibility bar is not currently set too low. The current system we have is the product of decades of work from dedicated bureaucrats and in fact is delivering robust outcomes in a very, very difficult area.

Prevention and early treatment of mental and physical ill-health should be the main game at this point. It has been known for years hostile employers and poor job satisfaction are among the most potent barriers to returning to work for those with either depression or back pain. Investing in ways of reducing workplace bullying and improving management standards, especially improving occupational safety issues would be an obvious, evidence-informed way of reducing the numbers becoming eligible for DSP.

A politician who is actually serious about reducing DSP eligibility should be embarrassed and ashamed about achieving this by denying genuine claimants instead of taking action to stop them ending up in that situation.

As for Mr Abbott’s characterisation of back pain and depression as “not permanent conditions” I can only shake my head. In fact, this may be the most damaging comment he made. In one throwaway remark, this politician of considerable influence speaking to a large audience reinforced perhaps the most ableist and ignorant stereotype that blights the lives of sufferers of those conditions.

Having been PM, he simply should have been more responsible. He did not take seriously two of the leading causes of disability and ill-health throughout the planet. These are not trivial problems you can get over with a “can-do” attitude or by “toughing it out”.

Graphic showing global causes of disability burden. Dr Andrew Briggs, presented at Australian Pain Society conference 2016

Someone with diabetes may have perfect blood sugar readings for months at a time if they manage their diet, exercise, and medications just right. They still have diabetes. Someone with persistent low back pain that has gone on longer than 12 months is always going to have to manage that pain: every day, forever.

People with serious mood disorders put enormous amounts of emotional effort into appearing better than they are so they are not judged by people saying exactly the sort of thing Mr Abbott did.

Nobody chooses to become eligible for DSP. It’s not a lifestyle choice that has anything to recommend it. If Mr Abbott (or any politician) truly cares about the very difficult issue of preventing working-age Australians ending up in the poverty trap of chronic illness, my door is open. I would be happy to collect a few dozen of my patients who receive DSP and let him tell me which of them I should have told they were fit for work after all. I might even point out a few useful policy ideas that might work in the real world.

A few hours of hearing about relationships destroyed, houses sold, family members alienated, jobs lost, children disadvantaged and lives generally upended by the onset of chronic illness might just be enough of a glimpse to enable Mr Abbott to learn to empathise. Perhaps it’s too much to hope for to get closer to ending the stigma of being disabled and unable to work. I’m probably being hopelessly optimistic to think there is even a genuine appetite for addressing even some of the entrenched discrimination my patients face from every employer they send a CV to.

I’d settle for simply seeing less of the unthinking ableism that makes life harder for those already up against it.

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