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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