In the summer of 2013, I attended a meeting of mental health patients to discuss the introduction of Personal Independence Payment (PIP). This was the new disability benefit brought in to replace Disability Living Allowance (DLA). Most of the attendees were DLA claimants, anxious about the transition, and fearful of having their benefits removed. The fears were not based on scaremongering but on their experiences of the Work Capability Assessment (WCA).
One of the lesser discussed legacies of the last Labour administration has been the introduction of medical assessments as a means of policing sick and disabled people’s benefit entitlement. In 2008, the government introduced Employment and Support Allowance, ensuring all claimants, after three months of their claim, would be subject to the WCA. This represented a significant shift in a number of ways (the removal of GPs from the sickness-certification process and the private outsourcing of benefit assessments, for example). For me, it was the first time my client group of people with severe mental health conditions had become subject to this type of regime. It was to lead to a substantial shift in emphasis in my own work, from proactively seeking to improve the take-up of benefits by patients to defensively reacting to their having their benefits reduced or taken away altogether. By the time the following Tory government introduced PIP, a significant toll had been taken on the morale and health of these patients, as many had suffered directly from the vagaries, inconsistencies and brutalities of the WCA regime.
The introduction of a similar regime of ‘independent’ assessments under PIP resulted in at least two negative and damaging impacts on claimants. The first was the removal of significant amounts of important income for people already living at or below poverty levels. The second was that many claimants were now subject to a never-ending cycle of assessments and reassessments, where the fear of a negative outcome for the subsequent assessment sometimes outweighed the direct impact. It meant that even those who never actually lost any benefit would often suffer a significant deterioration of their condition simply because of the constant inferences being made against all benefit claimants and their fear of the next reassessment.
To understand the dynamics of this process, it is important to recognise the impact of governments’ rhetoric, bolstered by periodic media campaigns aimed at othering benefit claimants and garnering public opinion in favour of reductions in benefit levels. This process peaked during the years after the 2008 economic crash and, in particular, following the decision of the new Tory/LibDem coalition government in 2010 to embark on a programme of austerity. Work and Pensions Secretary Iain Duncan-Smith’s argument for the implementation of Universal Credit was praised by many because it reduced the rate of withdrawal of means-tested benefits when claimants began to earn (or increased their earnings), but the emphasis on the notion that there is a direct correlation between benefit levels and the willingness of workers to take up work has always been at the heart of the ideological justification for the need to constantly regulate and control the benefits of sick and disabled people.
You could be forgiven for imagining that the upshot of over 15 years’ constant barrage of anti-claimant rhetoric and removal/reduction in benefits would be that claimant numbers would be down and we would have seen massive reductions in the welfare budget. Of course, none of this is the case. Claimant numbers have not reduced and the benefit budget is higher than ever. Here, it should also be acknowledged that, despite the rhetoric, claimant numbers and the amount spent on these particular benefits were never a huge proportion of the total benefits budget anyway.
Another feature of the last decade and a half has been the relative success of the welfare rights and advice sector in fighting back to prevent some of the worst impacts of the changes. Despite the bleak picture that I’ve outlined above, the position of many benefit claimants would have been even worse, were it not for the work of Child Poverty Action Group (CPAG) and other organisations to legally challenge some of the most egregious aspects of the legislation introduced. This has resulted in some negative elements being removed, as well as the Department for Work and Pensions being forced to soften its interpretation of other aspects. On the ground, a great deal of work has been done by local authorities and third-sector staff to support claimants through all aspects of the claim and appeal procedures. When I spoke to patients in that 2013 meeting, I explained that I couldn’t guarantee that they wouldn’t experience problems, but that mental health and local authority staff, as well as workers from Mind, the mental health charity, welfare rights agencies and others would all support them through it.
The experience since 2008 is that mental health staff and advice agencies have worked hard to support patients, with largely positive outcomes. Yet, all of this has come at a significant price. The amount of energy consumed in protecting service users from the pernicious effects of an uncaring social security system always comes at the price of reduced time and resources for more positive interventions aimed at actually improving their mental health.
Added to this is that the victims of negative welfare policies are not just those who are already experiencing severe mental health problems. I frequently see people who have been coping without direct support from mental health services and have fallen foul of negative decisions, often because they have been without that support. Their subsequent deterioration then brings them back into already stretched services, resulting in a spiral of deterioration experienced by both patients and those who support them.
So where are we now? Prior to the July 2024 General Election, the Conservative government had mooted further, harsher measures to restrict and reduce benefits paid due to incapability for work and had circulated a White Paper outlining various options for reducing the disability benefits bill. As yet, the new Labour government has given few direct clues as to its plans for disability and incapacity benefits. Much of the discourse has been framed by the need for economic growth, and Chancellor Rachel Reeves ominously talked about “difficult decisions” when announcing the intention to means-test Winter Fuel Payments. Meanwhile, most of the emphasis of Work and Pensions Secretary Liz Kendall (both during the election campaign and since taking office) has been on “helping more people get work, and get on at work”, and although a recent statement heavily criticised the previous government’s anti-welfare rhetoric, the insistence that she would not make reform “merely about cuts and blame”, still suggests that cuts and blame will make an appearance somewhere.
Allan Reynolds has over 30 years’ experience of working in Welfare Rights. These are his personal reflections on the impact of disability benefit policies on the mental health of claimants.
Image credit: Daniel Ali via Unsplash