This article titled “Mental health of benefit claimants is put at risk by welfare reform” was written by John Domokos and Patrick Butler, for The Guardian on Wednesday 20th June 2012 17.47 Europe/London
One day in May, a man arrived to sign on at Birkenhead jobcentre in Merseyside. He was late. He had been late repeatedly and had missed several of his fortnightly appointments altogether.
The jobcentre supervisor told the man that his poor timekeeping had become an issue and put him at risk of being “sanctioned”. “You have two options,” he said. “Start turning up to the appointments on time; or continue like this and your claim will be disallowed.” According to a health and safety report relayed to the Guardian, the man replied: “I have a third option.” He reached into his pocket, took out a knife, and cut his wrists.
Local police confirm reports of the incident and say the man was subsequently sectioned. The man is understood to have had a history of mental illness dating back to at least last August. He had been in receipt of employment and support allowance (ESA) for depression and arthritis, but in February he had been reassessed and found fit for work. He had started an appeal, but withdrew it and went on to jobseeker’s allowance.
Such incidents are rare and complex by nature. But they are part of a wider concern among health professionals, campaigners and claimants alike: that the mental health of some of the UK’s most vulnerable people has been increasingly put at risk by the government’s rapid attempts to push through massive cuts to the benefits system.
At the centre of the controversy is the work capability assessment (WSA), the test carried out in the UK by the French healthcare firm Atos that is designed to identify people on incapacity benefit who are “fit for work”. Critics say it fails to pick up complex and fluctuating conditions such as mental health. It is widely feared by vulnerable claimants – and for those who are found fit for work, it can trigger a long, stressful cycle of appeals.
Many claimants in Birkenhead who have trouble with their benefits end up at Mersey Advice, a welfare rights charity five minutes walk from the jobcentre dubbed by staff “the fourth emergency service in Birkenhead”. Simon Wilkinson, a caseworker, says the centre is so swamped by people needing benefits advice there is now a three-week waiting list to see him. “We are getting people who are massively on the edge, people who are genuinely close to killing themselves. It’s not scaremongering, it’s absolutely real.”
Wilkinson advises clients on how to appeal against being found fit for work. He estimates that he has been to 150 such tribunals in the past year and a half, winning 85% of them. He says at least half are related to mental health. “The crisis level here is massive, and I think it’s getting worse.”
Julie Carwardine, 42, from Caerphilly in Wales, suffers from fibromyalgia, an all-over muscular ache, and has three herniated discs in her neck. She developed depression, commonly associated with her condition. But, she says, it was her battle with the benefits and tribunals system that had tipped her over the edge when she attempted suicide in January.
“I can honestly say it was because of all this,” she says, pointing to a pile of benefits and appeals letters stretching back three years.
Julie had worked all her life and considered herself “highly employable” and a “go-getter” before she got ill. “I have come to terms with my illness, not being the person I used to be. It’s just the constant being in limbo that’s the worst thing.”
She has been through the appeals system three times, each time winning her right to keep her incapacity benefit.
But weeks after her latest successful appeal in March, a bombshell of a letter arrived on her doormat headed “About your employment and support allowance”. It told her that the length of time she could claim the contributory form of ESA was restricted to one year. “I was devastated. Every time I get another bit of bad news I just feel like I’ve been kicked again. It goes on and on. You constantly feel like you’re being doubted.” Because Carwardine’s partner works and because the change was applied retrospectively, she lost her £400 a month ESA the following month. She is now more reliant on her partner to financially support her and her two daughters – he earns about £800 a month, “though it varies”. This is causing tension between them, and “humiliation” for her. She has fallen behind with rent and bills, her bank has closed her account, and her doctor has doubled her dose of antidepressants.
This year, 100 family doctor practices based in some of the most deprived areas of Scotland carried out a survey to compare notes on how austerity measures and welfare reform had affected their patients.
They discovered that one issue dominated: the number of people presenting with deteriorating mental health.
These patients fell into two groups: the first were in work, and previously well. Yet they were now coming to their GP complaining of anxiety and stress as they grappled with increased job insecurity, cuts, and the pressure of extra work. The second group were patients who had chronic mental health issues and physical problems to begin with. They had been on incapacity benefit, but had been reassessed by the authorities, and found fit for work, a decision that cut their benefits. Many were consequently struggling financially. Some were self-medicating with drugs and alcohol, others upping their intake of antidepressants.
The GPs also found that this group of mentally unwell and disabled patients were coming to gather medical evidence to support appeals against WCA decisions they believed unfairly labelled them as “scroungers”. These tests, which consumed so much of their time and their patients’ energy, were “unnecessary [and] avoidable”, said many GPs. Others expressed anger and disbelief at the “medical inappropriateness” of some of the decisions.
One GP, responding to the survey, wrote of his discomfort at witnessing what he considered to be a “deluge” of “aberrant” fit-for-work decisions: “The last few months have been among the most depressing and disturbing times in my many years as a GP.”
Dr Peter Cawston, who works at the Drumchapel practice in Glasgow, said he saw a “strong sense of hopelessness and self-destructiveness” among ill patients who are found fit for work.
Part of what he calls the “emotional intensity” felt by these patients about the WCA is caused by the way they feel the system fails to understand often complex mental health issues, and assumes they are cheats. “People feel more humiliated. People feel destroyed. It’s partly financial, but behind it is a feeling that people are demeaned, not believed, their lives caricatured. People just come away [from the WCA] feeling belittled.”
A year ago, six academics and charity chief executives wrote a letter to the Guardian warning about the potentially fatal consequences of the “deeply flawed” work capability assessment. It was “causing huge amounts of distress” among people with mental illness. They called on the government to develop a “more sympathetic and supportive system”.
One of the signatories, Dr Jed Boardman, a consultant psychiatrist and spokesman on social inclusion at the Royal College of Psychiatrists, says that 12 months later, nothing has changed. “It’s certainly not better”.
Another signatory, Paul Farmer, the chief executive of Mind, resigned in April from the government’s WCA advisory panel in protest at what he felt was lack of urgency on the part of ministers to change a flawed system. “I genuinely don’t understand why the government just doesn’t pause the process and reflect on why it’s not working,” he said at the time.
Up to half of the 11,000 people who undergo the WCA each week appeal against the decision; 40% of appeals are successful. Appeals cost the taxpayer £50m, on top of the £100m a year paid to Atos to carry out the tests.
A year ago, Boardman and Farmer warned that mentally ill people killed themselves because of benefits-related problems. Since then, as the process of reassessing people on incapacity benefit has accelerated, a report from coroners’ courts have revealed a number of cases in which benefits-related anxieties are mentioned as a contributory factor to a person’s suicide.
The Department for Work and Pensions (DWP) said that it strived to constantly improve the system. Jobcentre staff are “well trained” to deal with vulnerable customers and those at risk of self harm. It said the “descriptors” – the framework used to assess whether a mentally ill person was fit for work had been made clearer and more consistent. A spokesman said: “We have worked hard – and continue to do so – to improve the way the work capability assessment works for those with mental health issues, but it is right to reform the welfare system. The old incapacity benefits system let down too many people by simply writing them off to a life on benefits, which did nothing for their wellbeing.”
A spokesman for Atos said: “Atos does not set the criteria for assessments or make benefit decisions but we have improved the way we assess those with fluctuating and mental health conditions. All our doctors, nurses and physiotherapists have received specific training in mental health and there are now mental function champions in place across our centres to offer specialist advice and support.”
Doctors and academic experts agree there is no evidence to prove there has been an increase in benefits-related suicides. But most accept that there is a growing accumulation of tragic stories that reflect the extreme despair many claimants feel.
Farmer, who has heard first-hand from the families and loved ones of people who have killed themselves, chooses his words carefully: “I don’t want to scaremonger, but the consequences of getting it [the WCA process] wrong are already being seen. People have found themselves in unbearable and intolerable situations.”
According to Neil Coyle, policy director at the charity Disability Rights UK, ministers and officials accused charities of “scaremongering” when they pointed out in at least two private meetings over the past year that removing benefits could have tragic consequences for some disabled and mentally ill people.
But such accusations are today challenged by new evidence seen by the Guardian showing that the DWP is aware of the problem. It recently sent an email to job centre staff asking them to ensure “every customer contact is handled with the utmost care and sensitivity”.
Jobcentre staff, it said, were making “difficult changes which some of our more vulnerable customers may take some time to accept and adjust to”, and that “the consequences of getting this wrong can have profound results”.
A DWP claimant, it added, had recently attempted suicide as a result of being told their benefits would be stopped.
Jobcentre staff say they are ill-equipped to deal with vulnerable customers with serious health problems who are being found fit for work. According to one job centre union rep: “The vast majority of [staff] don’t have any training whatsoever for dealing with people with mental health issues, so are unequipped to deal with them.”
Another said: “Sometimes the customer asks, ‘What am I supposed to do … how am I supposed to live?’ There is nothing we can tell them.
When they [claimants] realise there is no safety net for them, the phone goes silent and they hang up. You wonder what will happen to that person. It’s heartbreaking.”
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