Mental health claimants fear slide into poverty in benefits shake-up

    People on incapacity benefits may have won the argument against
    their payments being slashed or time-limited, but fears have
    emerged that vulnerable claimants will be docked £20 a week if
    they fail to do enough to seek work.

    Disability and mental health campaigners are particularly
    concerned that people with mental health problems – who account for
    more than one-third of those on incapacity benefits – could be
    penalised for appearing uncooperative to Job Centre Plus staff.

    Buoyed by the results of a survey suggesting that one million of
    the 2.7 million people on incapacity benefits want to work,
    ministers have devised a way to achieve this that wields both the
    carrot and the stick.

    The carrot is the roll-out of Pathways to Work pilots, under
    which personal advisers help claimants to find work and
    participants receive NHS rehabilitation and a £40-a-week
    credit if they take a job.

    The stick is that, under proposed changes, participation in
    these schemes would be compulsory for everyone whose condition is
    judged “potentially manageable”.

    The penalty for refusing to engage in Pathways to Work would be
    having benefit pegged at £55 a week, the same level as the
    Jobseeker’s Allowance. Those who do take part would receive the
    full benefit, likely to be £74 within 12 weeks, instead of a
    year as present rules dictate.

    As work and pensions secretary Alan Johnson puts it: “More money
    than now for those who take up the extra help on offer; less money
    for those who decline to co-operate.”

    The big question is which conditions will be judged “severe”,
    entitling claimants to a higher rate, expected to be about
    £80, and which are “potentially more manageable”, where
    claimants will be required to seek work in order to receive more
    than £55 per week.

    Ministers suggest terminal cancer would be an example of the
    former, while back pain would be in the latter group. Between these
    extremes though, things are far from clear.

    “People who have claimed incapacity benefit have too often been
    told that they should not expect to work again,” Johnson says. “But
    there is growing medical evidence that for many conditions, such as
    back pain and depression, working is much healthier than being

    At present, one fifth of claimants are exempt from a medical
    examination by government doctors. They have conditions on a
    limited list which includes tetraplegia, dementia, terminal illness
    and persistent vegetative state.

    The list does not include severe mental illness or learning
    difficulties, or many other chronic physical conditions, and
    campaigners suspect that the same list would be used to distinguish
    between the two groups of claimants under the new system.

    Mental health campaigners are worried that the result will be
    thousands of people with mental illness having their benefits

    Lorna Reith, chief executive of the Disability Alliance, says:
    “Pathways to Work appears to be successful in getting people off
    incapacity benefit and back to work. So why bring in the big

    “The group we are most concerned about is those with mental
    health problems. Someone may come across to an adviser as
    difficult. Is the government seriously suggesting that junior Job
    Centre Plus staff are to decide whether someone who has had a
    mental breakdown is ready to start looking for work?”

    Sophie Corlett, policy director of mental health charity Mind,
    agrees. “It’s monstrous that people with mental health problems
    could be punished by having their benefits cut for appearing

    There are also concerns that pressure to find a job may make
    some psychiatric conditions worse.

    Marjorie Wallace, chief executive of the mental health charity
    Sane, warns: “We fear that because the reasons why people with
    mental illness cannot work can be far less obvious than in the case
    of those with physical conditions, the increased pressure on
    individuals who are mentally frail may push them over the edge,
    triggering a relapse.”

    John Wheatley, senior policy officer for Citizens Advice, says
    the Department for Work and Pensions already has a poor record for
    tailoring its services to the needs of people with mental health

    “We are concerned that, with 30,000 jobs being lost from the
    department [as part of the government’s efficiency drive], it will
    be impossible to provide the advice, training and support that many
    people with disabilities will need to make it back into work.”

    There are hints in the department’s strategy paper that doctors
    will be taking more account of claimants’ capacity to be
    rehabilitated back into the workforce. At present, campaigners
    argue that assessments are weighted against people with mental
    health problems – downplaying behaviour that could have serious
    implications in the workplace.

    Corlett says: “The doctors use a point scoring system, and
    mental health criteria have a lower points rating than physical
    problems. So inability to answer a phone ranks as being more
    severe, while the less severe would be ‘frequently distressed due
    to fluctuation of mood’ and ‘gets upset by ordinary events
    resulting in disruptive behaviour’.”

    Reith says: “The test is about functionality at the moment, with
    questions such as ‘can you stand?’. Employers are more interested
    in whether you will turn up every day, how many hospital
    appointments you will have to attend and whether you will be

    More than half of appeals against the refusal of incapacity
    benefit by medical assessors are upheld. A dossier produced by
    Citizens Advice in 2003 details cases where medical assessments
    were perfunctory or stated that an applicant should be working –
    against the advice of their GP or consultant.

    For instance, a man with severe heart disease was told he should
    not be working by his GP. The medical assessor disagreed and
    refused benefit. The man had a heart attack five months later.

    The case makes an interesting contrast with the DWP’s claim that
    patients often misinterpret their GP’s signing of a sickness
    certificate as “an order not to work”.

    Nevertheless, there is widespread relief among disability groups
    that the government did not choose to cut the basic rate of the
    benefit or placing a time limit on claiming it.

    Though the stick was smaller than first feared, whether it is
    needed to prevent abuse of the system is another matter. Work and
    pensions minister Baroness Hollis admitted only last October that
    fraud in disability benefits was “extremely limited”.

    The New System 

    • Initially claimants to be paid a holding benefit of £55 a
      week until undergoing a personal capacity assessment (medical
      examination), normally within 12 weeks. All claimants to undergo an
      employment and support assessment to help plan a return to
    • The 20 per cent with the most severe health conditions to
      receive the higher disability and sickness allowance, at about
      £80 a week. No requirement to engage in return-to-work
      activity, although this is encouraged.
    • People with “more manageable” conditions to receive the
      rehabilitation support allowance, of about £74 a week.
      Requirement to attend work-focused interviews and engage in
      training or preparation for seeking work. Refusal to engage could
      result in a return to holding benefit rate.
    • The current incapacity benefit to be scrapped initially pays
      £56 a week to all claimants, rising to £74 after a year.
      It makes no distinction between those able to work and those who

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