It’s the tests that deceive, not the people claiming benefits | March 19, 2011

Mental illness fluctuates. A one-off assessment of fitness to work is not only inadequate, it’s making people’s conditions worse

  • Zoe Williams
  • The coalition came into government with a firm belief that an army of shirkers was bleeding the state dry with fake disabilities. That much has always been clear from Cameron’s rhetoric: the benefits system, he says, has created a benefits culture. The Tories want to end this culture once and for all; in the case of the disability living allowance, by reassessing claimants. The last government introduced the work capability assessment for new claimants; the difference now is that all claimants have to be assessed.

    In Burnley, the trial of the WCA has just ended. Its weaknesses are many and varied, but in a nutshell, the system is that you chuck as many people as you can into the deep end and whoever floats long enough to take you to tribunal, well, congratulations. Think of a 16th-century witchcraft trial, take away the transparency and public approval, and you have it about right.

    The focus so far has been on the absurdities of the physical disabilities that have been discounted by the WCA: claimants have to score 15 points to stay on the full allowance. A person with multiple sclerosis scored zero, despite a surgeon’s letter stating he was too ill to work. Someone who was registered blind was found to have “mild visual impairment”. Charities warn that the coalition’s whole welfare reform bill penalises cancer patients.

    But the assessment for those with mental illness is even more bafflingly inadequate. Atos, the company responsible for the assessments, does not require staff to have any training in or understanding of mental illness. There’s an anecdote about an assessor telling a claimant that because he wasn’t rocking or sitting in a corner, he obviously wasn’t unwell. Claimants are asked how they arrived at the appointment: if they managed to take public transport alone, and are presentably dressed, this counts strongly against them. Likewise, if they are articulate. So there’s no acknowledgement that mental illness fluctuates, and someone might be fine on one day, but incapacitated the next.

    Sharon McConville, who has been diagnosed at different times with major depressive disorder, bipolar affective disorder and schizoaffective disorder, is unusual in speaking openly about the WCA’s inadequacy, as it applies to her personally: “There is huge variability in my condition – on a given day I may be depressed, hypomanic, psychotic or relatively well – and I find it hard to see how a face-to-face meeting at one point in time can accurately determine the level of support which is necessary to help me function as well as possible from week to week, month to month.”

    At the same time, there’s no understanding of people whose illness has a high anxiety component, who might never even open their post, let alone be able to face an appointment. You’re damned if you do turn up, and damned if you don’t. There is no provision set for conditions in which the patient might have poor insight into his or her own illness. A survey by the mental health campaign Rethink of the people who have been reassessed so far showed that only 12% felt that the assessor had even understood their condition; 80% said the stress and anxiety had worsened their health. The WCA is so riven with faults that it’s hard to see what kind of mental illness would, under its terms, actually qualify someone for help.

    So, typically, this might result in the treatment meted out to Man A (he wishes to remain anonymous) who has bipolar disorder, and suffers severe depressive episodes that can last up to two months, several times a year. He scored zero on his Atos test last March and his invalidity benefit was stopped. As a result he became stressed, his symptoms worsened and he had frequent suicidal thoughts. He had to wait 11 months for his appeal, at which the judge said he had no case to answer, and he will now receive his backdated benefits. He said after his appeal: “I am relieved the decision has gone in my favour, but I am also very angry. The result of my appeal just goes to show how flawed the current system is – with no political opposition.” This last point is vital: it’s rare for someone with severe mental illness to want to be identified, let alone have the stomach for a public meeting, still less a campaign. Political opposition to the WCA needs to be much more muscular.

    But before you even consider the politics behind all this – whether removing benefits from anyone is a fair way to stimulate employment when there is a shortage of jobs – there’s a clear discrimination case to answer. The argument about whether or not mental illness counts as a “real illness” has been fought and won. To devise a test, therefore, that might (patchily) assess physical impairment but doesn’t, except in the crudest terms, address mental illness, is discriminatory.

    Furthermore, if you have arthritis and your benefits are cut, your life will get worse but your arthritis won’t, necessarily. If you have depression and you are treated outrageously by a system that was apparently designed to reject your legitimate claim, then your depression very probably will worsen. Tribunals may sort out the injustice suffered by individuals, but what this situation demands is a class action against the discrimination that underpins it.

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