PIP and Mental Health

I’m ashamed to live in a country which applies a presumption of guilt to disability benefits claimants. At best, the system stigmatises and humiliates without lasting effect to health or benefits. At worst, this cruel system not only results in people losing essential financial help but also risks making their condition worse. I was asked my views on benefits, specifically PIP for people suffering from mental illnesses. I thought about it and decided I don’t have a 140 character answer to whether people who are mentally ill should be reassessed for PIP. Well, I do. The answer is no but I’m a lawyer and that’s not how we roll. I wanted the time and space to really think about it. I’m not breaking new ground and I’m not an expert on mental ill health by any means. If you suffer from mental illness or know someone who does or actually are an expert, please feel free to tell me if you think I’m getting it wrong here. The question I was asked was a broad one, encompassing “common mental health problems” and psychotic disorders. Common mental health problems include generalised anxiety disorder, mixed anxiety and depressive disorder, depressive episode, phobias, obsessive-compulsive disorder and panic disorder. Psychotic disorders include schizophrenia and other delusional disorders, manic episodes and bipolar affective disorder and other affective disorders with psychotic symptoms.

When I saw Lynn Blackmore’s petition to exclude people with certain serious mental illnesses from PIP assessments, I thought of one father’s description of his son’s struggle with paranoid scizophrenia The UK has a long and shameful history when it comes to mental illness. This is amply demonstrated by statistics on the prison population and homelessness. In 2011, the Law Society Gazette reported that 90% of prisoners in England and Wales suffer from some form of mental illness. 90%. Over and over again reports have been written on the extent of mental illness and learning disabilities among criminal defendants and the prison population but, far from getting better, the picture can only get bleaker as cuts across the board, in healthcare, education, social care, welfare and Legal Aid take hold. Rather than trying to narrow figures on homelessness down to a similar single figure I’d recommend this report which sets out interesting worldwide research. People with the most severe forms of mental illness are routinely failed. They also have the greatest need and DLA provides vital support in their care. I’d like to think that most people would agree that people like Lynn Blackmore’s son and (before his recovery) Jonathan Rayner’s son should receive PIP without any argument. However, the fact that one of the most vulnerable groups in society is consistently shortchanged by so many different state agencies suggests that there’s far less compassion about than I might like to believe. Still more cynical is the thought that it’s their very vulnerability which makes it so easy for the state to not just allow them to slip through the cracks but to actively drop them through them by means of wilful neglect.

DLA is not about whether a person is or isn’t working. It’s provided on the basis of medical need, with mobility and care components. The care component provides vital support for people suffering from mental illness (and their families). Unfortunately, the level of public debate (particularly in the media) seems to be so poor that the two issues are conflated and people could quite reasonably conclude that the Government’s message on DLA is “they’re costing you money. They refuse to work. They don’t need these benefits.” The nature of mental illness being what it is and the test for DLA being what it is, it probably is the case that most (if not all) people on DLA due to mental illness are also unable to work but it’s disingenuous to imply that DLA is paid on any basis other than need. As far as ESA is concerned, society needs to accept that there will be periods in mentally ill people’s’ lives where they are unable to work. Some will never be able to. It’s also extremely difficult for mentally ill people to find and keep work, even when they are medically able to work. As you know if you’ve read my previous post How Many Elephants, I believe it’s rank hypocrisy to move people from ESA onto unemployment benefits without doing anything to change public perceptions of disability as a whole. In researching that blog, I found that only 10% of mentally ill people are in work. Even if you are the most reactionary person in the UK, you surely can’t believe that 90% of mentally ill people are “skivers”? So, enough pandering to the Government’s desire to shift the goalposts on the issue of DLA.  Just over 1% of the working-age population is receiving DLA for reasons associated with mental health, a far lower figure than estimates of the prevalence of more severe mental health problems in the population as a whole(Responsible Reform Report). The number of DLA claimants with a mental illness has increased since its introduction but there isn’t evidence to support any view that this is due to abuse of the system. In fact the Report I just mentioned cites a WHO study saying that mental illnesses have been increasing globally.

It seems fair to suggest that some forms of mental illness, particularly “common mental health problems” such as depression and anxiety disorders are often treatable, in which case, they might not give rise to DLA entitlement under the current system or they might only result in a relatively short period of entitlement. Between 8% and 12% of the UK population suffer from depression in a year yet only just over 175,000 people with “psychoneurosis” (which includes other forms of mental illness such as anxiety) received DLA in 2011 (see table). Relatively speaking, very few people with common mental health problems are in receipt of DLA at any given time. Only the most severely affected will meet the strict criteria already in place for DLA. People suffering from such conditions may well be entitled to DLA and ESA at various times in their life. I’m not being dismissive of them but, with treatment, many people are able to manage to a sufficient extent that they either don’t need DLA at all or won’t continuously meet existing thresholds for DLA. This is relevant to the image of people spending “a lifetime on welfare” we’re often sold.

It’s the duty of the healthcare system to ensure those suffering from common mental health problems (and indeed all mental illness) have the help they need in order to give them the best possible chance of recovery and/or management. While treatment is ongoing or if the healthcare system fails them, social security should step in, in the way it should for a physical condition which the health service fails to treat. Of course, the mind being the astonishingly complex thing it is, general rules can be risky. Some people won’t respond to treatment (my experience with my own brain chemistry’s sick sense of humour when it comes to pain signals makes it easy to see this, even if I haven’t experienced it in a mental health context) and the results could include chronic mental ill health and/or a broadening of symptoms or even new additional conditions. This isn’t the fault of the mentally ill individual but if compassion is lacking in the discussion over psychotic disorders, it seems to be utterly absent in relation to common mental health problems. Most people accept that they can’t begin to understand what it’s like to be inside the mind of a paranoid schizophrenic but they’ll take a far more cavalier attitude to conditions like depression. They think, for example, they know what it means to be depressed. The word is bandied about by people who’re just having a bad week.

Subjective conditions make easy targets because people can convince themselves that they do know what it’s like and they can choose not to believe what they are hearing about the subjective condition. Nobody other than the people with the subjective condition can really grasp what it’s like and even people with the same condition will experience it differently. That’s why it’s so easy for the Government and media to claim that certain conditions are particularly open to abuse. I don’t suffer from mental illness. I don’t understand what it’s like to be depressed, have an anxiety disorder or any other form of mental illness but I do have a subjective condition so this is a question I’ve thought about a lot in the context of my condition. That’s my starting point for considering the failure in empathy towards people with mental ill health, I suppose. Lack of empathy shouldn’t be the automatic response to health problems we haven’t experienced but it does seem to be widespread. By way of example, people may lack empathy for others whose depression is triggered by a specific personal crisis like bereavement, divorce or the loss of their job whereas ex-servicemen suffering from mental illness are a rarity in the discussion of mental health because other people tend to be more sympathetic to them. They see an “objectively reasonable” cause to trigger the mental illness. As a society, we need to move past that approach. There’s no point asking ourselves how we would respond in someone else’s shoes. We’re likely to kid ourselves into believing both that we’re “stronger” than that other person and that too many people don’t just “get on with things”. As a nation, this is signalled by our love of the stiff upper lip, Blitz spirit: keep calm and fucking well carry on. Our image of ourselves as a society is predicated on the (probably unhealthy) rule that we shouldn’t wear our hearts on our sleeves and should muddle along (“oh. Y’know. Mustn’t grumble”). Unfortunately, this approach completely ignores the illness element of mental health. The whole point is that people suffering from mental ill health experience life differently to the “normal” people who judge them so harshly.

By failing to understand this society opens the doors to the Government and the Tabloids. We enable them to spread stories smearing people with mental health problems. Only those with the most severe and chronic conditions are entitled to DLA under the present system. We ought to have the decency to admit that those people go through enough as it is, without putting them through the trauma of a WCA, not because their own condition has changed but because the Government wants to tinker with entitlement criteria until it succeeds in moving as many people as it can off disability benefits. Mental health charities have expressed serious reservations about the draft PIP descriptors, with MIND saying the DWP

“did not adequately consider issues such as fluctuations in symptoms, the management of medication and therapies, financial management, and problems with engaging socially. Concern was also expressed that the proposed PIP assessment did not ensure that disabled people were able to remain safe. Whereas DLA considers specifically if someone faces substantial risk if there is no one to watch over (supervise) them, PIP does not.”

I believe it’s both unnecessary and (if the system used is anything like that used for ESA, which is more than likely) cruel to put any mentally ill person currently on DLA through a WCA. If the DWP wants information about the current state of their health it should either be able to get it from the current medical professionals treating the individual or knock heads together until that person gets off a waiting list and into treatment.

Personally, I don’t agree with WCAs in their current form for anyone. Even if we weren’t hearing truly horrific stories about ATOS, I’d still believe that any disabled and/or ill person would be put at risk by WCAs in this form (based on my own experience of assessment for an insurer) and that people with mental health conditions would be in a high risk group. So, in addition to believing that those people who have mental health conditions and are on DLA shouldn’t be put through a WCA for PIP, I also believe that those who are on ESA and are put through a WCA (and potentially moved into the work related activity group or off ESA altogether) could actually be put under such strain that the whole process makes their condition worse and, potentially, leads to a greater likelihood that someone suffering from a common mental health problem could be at greater risk of developing a more intractable condition as a result of the process. That’s my entirely non-medical view.

People who suffer from the most severe forms of mental illness and/or have learning disabilities are treated appallingly in the UK and there is no halcyon age to look back on. It’s getting worse but it’s never been good. It would take effort and investment in healthcare & social care, education, social security and the justice system to improve matters and there is little appetite for that. Lynn Blackmore’s petition needs 10,000 signatures by 20th March just to trigger a response from the DWP to her plea to exclude severe and enduring mental health sufferers from reassessment for DLA/PIP purposes in 2013. She still needs nearly 3,000 signatures at the time of writing. In addition, to call for a full impact assessment of all disability benefits reforms, you can sign the WOW Petition

Post on guidance for PIP claimants with mental illnesses.