Psychiatrist Links WCA To Mental Health Relapses
Tougher “fit for work” tests introduced to assess eligibility for disability benefit have caused relapses in patients with serious mental health conditions, according to a consultant with the Royal College of Psychiatrists.
Dr Jed Boardman, a consultant psychiatrist at the South London and Maudsley NHS trust, said the work capability assessment (WCA) discriminates against those with mental health issues and called for an overhaul of the process.
Boardman, who treats patients with serious and long-term mental health problems, told the Guardian: “People with severe long-term problems get very distressed about being assessed, probably because mistakes are made, because the process isn’t perfect, because they don’t feel they are being listened to in their interviews.
“You do see people relapsing as a consequence of getting distressed.”
His comments follow a study, published last week, that linked the WCA tests with an additional 590 suicides, increased mental health problems and hundreds of thousands of antidepressant prescriptions. The study, published by the Journal of Epidemiology and Community Health, showed a correlation between worsening mental health and assessments under the WCA, but did not say definitively that it was the cause. The Department for Work and Pensions described the study as “misleading” because researchers had no evidence that those with increased mental health issues had undergone a WCA.
In a letter to the Guardian, the study’s main author, Benjamin Barr, said it was crucial the DWP takes seriously concerns that WCAs are “severely damaging” mental health. He called on the department to release data it holds to researchers to allow further analysis of the health impact of the controversial test.
“Their primary criticism of our study is that we don’t have data specifically on people going through the WCA and consequent mental health problems,” said Barr, from the University of Liverpool. “They have data on who has died following the WCA and they could facilitate linkage of that data with health causes.”
Thousands of claimants have died after being found fit for work, according to statistics released in August by the DWP, following a freedom of information request. Ministers insisted that the figures they have released could not be used to link claimant deaths to welfare reforms, but the government has refused to release figures that would make it possible to assess whether the death rate for people found fit for work would be higher than normal.
One million recipients of disability benefit in England went through the test between 2010 and 2013, researchers found, while another million were expected to be assessed this year.
Boardman’s concerns are echoed by psychologists and benefit advisers working with claimants, who say they have anecdotal evidence that WCAs cause additional distress for those with mental health issues.
Toby Chelms, a cognitive behavioural therapist for the NHS in Leeds, said he has had to alter treatment plans for patients after “dips” in their conditions following WCA tests. Others have cancelled appointments with him after having their benefits stopped, because they can no longer afford the bus fare, he said.
“I have seen clients who can barely leave their homes due to anxiety, depression, PTSD [post-traumatic stress disorder] or obsessive compulsive disorder be deemed fit for work and therefore have their benefits cut or removed,” Chelms said.
“I’ve certainly seen people who have started treatment and have spikes in anxiety or depression following the outcome of the tests. People with mental health issues are very self-critical and ashamed of themselves and we’re trying to reevaluate that critical self thinking. But if someone in authority says: ‘You’re fine to work’, it can set them back.”
Boardman said the WCA failed to take account of “the fluctuating nature of the symptoms of the real-life person being assessed”.
“Quite often you can see in front of you someone who is trying hard to appear normal,” he said. “People very rarely play up their symptoms; they play them down.”
Numerous reviews of the WCA, including a select committee review in 2014, have expressed concern over the assessment’s applicability to mental health. According to the most recent independent review, almost 50% of those assessed under the WCA have a mental health problem as a primary condition.
Psychotherapists, advisers and a number of claimants who contacted the Guardian this week after a callout suggested those with mild or moderate mental health problems are also being impacted by their experience of the tests.
Markus Greenwood, the chief executive of Mind in Salford, said the charity’s benefit advisers have a high success rate – 65% – for those they help appeal WCA decisions via tribunals.
He said clients tend to play down their conditions when dealing with the WCA assessors and often benefit advisers have to step in to clarify what they are actually suffering from. “Because of the stigma that is still associated with mental health, people don’t want others to know that they are suffering,” Greenwood said. “If they are in front of an official, they might not disclose the extent to which they are incapacitated.”
A DWP statement said: “The health professionals who carry out work capability assessments are highly trained to assess people with mental health conditions.
“We have worked closely with medical experts and charities to make significant improvements to the WCA process and the percentage of people with mental health conditions who get the highest level of support has more than tripled since 2010.”